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After / Extended Hours Clinics

  1. Default After / Extended Hours Clinics
    Medical Coding Books
    If a family practice clinic offers extended and after hours care, is if apprpriate for them to bill cpt code 99050? Their regularly scheduled hours are Monday - Friday 8 am to 4:30 pm and their extended hours are Monday - Friday beginning at 5 pm at which time they no longer have scheduled visits (they see walkins). Thanks for your input.

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
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    99050 is for use for services rendered during times when the office is ordinarily closed. You state the office is open in the evenings so these are secheuled evening hours, I would use 99051. But remember these codes are to be used as additional codes with whatever the code for the service rendered is.

  3. #3
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    can somebody help me with guidelines (what is the time frame for these codes) One person said 6.00 pm onwards.One physician said as long as the patinet is with phycian after 6 pm (Example: pt had appt at 4.30 pm after triage and everything pt was seen by physician at 6.15 Pm) .Do you go by Appointment time or ?? I am confused.

    Need help

    Thankyou

  4. #4
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    After hours code "times" vary by insurance. Typically they start when the insurance company closes for the day. Like for example Anthem, 5p. When you go through credentialing you specify your office hours. If you see patients outside of these hours, it's after hours.

    If a patient has an appointment scheduled at 430p and they aren't seen until 615p... I would definitely not charge the after hours fee. The reason why is because most insurance contracts state an amount of "waiting time" that is acceptable to their standards. A 2 hour wait, even though we all know it happens, is not at their standards. So, if you charge the after hour fee, the patient gets an EOB or bill, and calls insurance and argues that they were there at 430p.. you might get dinged.

    I count it when the patient steps foot into the door.

    Food for thought -- I know of a clinic who decided they were going to establish a new tax id for after hours care because it became too overwhelming with the insurance billing. So, they accept no insurance, and charge a flat rate of $50 per visit. Only acute care, no preventative encounters, no refills.
    Last edited by ARCPC9491; 06-29-2009 at 02:00 PM.

  5. #5
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    Quote Originally Posted by ARCPC9491 View Post
    After hours code "times" vary by insurance. Typically they start when the insurance company closes for the day. Like for example Anthem, 5p. When you go through credentialing you specify your office hours. If you see patients outside of these hours, it's after hours.

    If a patient has an appointment scheduled at 430p and they aren't seen until 615p... I would definitely not charge the after hours fee. The reason why is because most insurance contracts state an amount of "waiting time" that is acceptable to their standards. A 2 hour wait, even though we all know it happens, is not at their standards. So, if you charge the after hour fee, the patient gets an EOB or bill, and calls insurance and argues that they were there at 430p.. you might get dinged.

    I count it when the patient steps foot into the door.

    Food for thought -- I know of a clinic who decided they were going to establish a new tax id for after hours care because it became too overwhelming with the insurance billing. So, they accept no insurance, and charge a flat rate of $50 per visit. Only acute care, no preventative encounters, no refills.
    Thankyou for your help

  6. #6
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Arrow
    The code you are looking for is 99051, services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service. I have never heard of this having anything to do with insurance companies' hours. This code was created to provide additional compensation for urgent care centers and other practices which stay open later and on weekends/holidays. These are times which are generally not as busy as regular (9-5) office hours, but the practice maintains a full staff on the payroll. At a time when most other physician practices are closed, this small after hours fee is a big savings for the insurance companies compared to the charges the patient would acquire if they have to go to the ER. Unfortunately, more and more insurance companies are discontinuing the payment of 99051, despite the savings you are affording them by being open during these hours. My recommendation is to include this exclusively in the contract negotiations with your payers. It is a legitimate charge. If you provide the service, you should be paid for it.

  7. #7
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    Quote Originally Posted by halebill View Post
    The code you are looking for is 99051, services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service. I have never heard of this having anything to do with insurance companies' hours. This code was created to provide additional compensation for urgent care centers and other practices which stay open later and on weekends/holidays. These are times which are generally not as busy as regular (9-5) office hours, but the practice maintains a full staff on the payroll. At a time when most other physician practices are closed, this small after hours fee is a big savings for the insurance companies compared to the charges the patient would acquire if they have to go to the ER. Unfortunately, more and more insurance companies are discontinuing the payment of 99051, despite the savings you are affording them by being open during these hours. My recommendation is to include this exclusively in the contract negotiations with your payers. It is a legitimate charge. If you provide the service, you should be paid for it.


    I would told by Anthem and another insurance, I think Cigna, that they consider the charge to be "billable" when they are closed. Weird, yes, but that's what both the provider reps told us.

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