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99051 -exactly does this code work

  1. Default
    Medical Coding Books
    Quote Originally Posted by daniel View Post
    The descrition given by Rebecca, is way off. Just looking at the CPT book, you can see this. This code is used for when a patient disrupts the physicians schedule. Like a patient seen on a walk in basis.
    During regulary scheduled evening, weekend, or holiday office hours, in addition to basic services.

    And about the other, respondent. Saying you can't collect the money up front for a walk in patient. Give me a source that tells me other wise. Why would this not be in compliance. You tell the patient up front when they come in, that they have to pay. $15.00 or $25.00 extra out of pocket, for seeing them on a walk in basis. Remember your providing a extra service for them.

    Keep in mind, I still use this code 99051. But I recommend practices just collect this money up front.

    Respectfully
    Daniel
    cpc

    Daniel,

    As the 'other respondent' I would like clarify my opinion.
    My post including "Can you..." and "think" should have been your first indication that I was offering an opinion about the subject... not identifying resources should have been your other.
    I highly suggest contacting each insuance company in which you participate directly - they will be your most accurate 'source'. Some payers pay the 99051 - others do not.
    Compliance with your individual contracts is the issue here. If the code is payable without any patient responsibility, then you are not following the regulations of your contract by collecting money upfront from the patient. Another question to ask your carrier would be, 'are we within our rights to bill a patient for this service knowing you do not cover the procedure/ service?"
    Always be sure to cover yourself with each carrier before incurring penalties due to an audit!
    Have a wonderful day!

  2. #12
    Default Rebeccawoodward.
    Hey rebeccawoodward.
    I meant no disrespect, in the way I posted my comment regarding your comment you made on CPT 99051. Just passionate about what I do at times. LOL.

    Respectfully
    Daniel
    CPC

  3. #13
    Location
    North Carolina
    Posts
    3,126
    Default
    Ditto~

  4. #14
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    It's really sweet that everybody is getting along now. Our practices are open until 8pm on weekdays and 5pm on weekends, during which time we are strictly "walk-in". We use code 99051 regularly, because it meets the description, "during regularly scheduled evening, weekend, or holiday office hours...". Many carriers pay it, many do not. We do not collect upfront for this charge (except of course, for self-pay). When the charge is disallowed by a carrier, we write it off. Otherwise, we collect the allowed amount by both the carrier and the patient. There may not be RVU's for this code, but it does pay, and the rates are carrier specific. If you are a practice who can charge this code, and you are not, YOU ARE LEAVING MONEY ON THE TABLE. Check with your carriers to see who will allow it and who will not. Forget about Medicare, Medicaid and Worker's Comp. Include this code in your contract negotiations with your payers. You are caring for their members at a time when most other practices are closed. Think of all the money they are saving by paying you this little 90551 code, rather than paying the ER!

    Bill Hale, CPC

  5. Default
    In urgent care we use 99051 quite often and are reimbursed for it. It is not meant to be used just because someone doesn't have an appointment - none of our patients had appoitments. It was designed to compensate the practice for additional costs in staying open extended hours (like labor costs). Never bill it to Medicare - they do not pay it but many other do. It sounds to me like you would qualify for the code after 5:30, weekends and the designated holidays outlined.

  6. #16
    Default
    You can not collect money up front for services such as 99051. You can also NOT charge extra for walk-ins over scheduled patients. This is ILLEGAL. You CAN however ask a patient to sign an advance beneficiary notice if you think their insurance will not pay for the services. This would hold them financially liable after the services are denied.
    If you do charge extra in advance for the 99051, you would have to refund the money to the patient after insurance pays, as you are not legally able to charge the patient the difference between the allowed amount and the billed amount. So if the insurance pays 100%, there is no balance, and a refund must be issued. If an insurance company pays at 80% but has you adjust the balance to zero, stating patient responsibility zero, you still have to issue a refund. Also, if the insurance company states that the services are not billable (or what have you), and tell you to adjust to zero and issue no payment (and still state patient responsibility zero), you again would have to issue a refund to the patient.
    The only kind of "extra" charges you are allowed to charge a patient for is for returned/bounced checks, and if your office has a no-show policy that results in a charge.

  7. Default
    I work the front desk on certain Saturdays at my office, and while looking at verification printouts, I have seen "$20-PCP During Hours, $25-PCP After Hours." Is that what you mean by charging the patient extra for it? I have charged the additional $5 if it is indicated on the printout.

    OUt of curiosity, how do you guys use 99050 versus 99051?

  8. #18
    Thumbs up I totally agree
    Quote Originally Posted by augustine104 View Post
    You can not collect money up front for services such as 99051. You can also NOT charge extra for walk-ins over scheduled patients. This is ILLEGAL. You CAN however ask a patient to sign an advance beneficiary notice if you think their insurance will not pay for the services. This would hold them financially liable after the services are denied.
    If you do charge extra in advance for the 99051, you would have to refund the money to the patient after insurance pays, as you are not legally able to charge the patient the difference between the allowed amount and the billed amount. So if the insurance pays 100%, there is no balance, and a refund must be issued. If an insurance company pays at 80% but has you adjust the balance to zero, stating patient responsibility zero, you still have to issue a refund. Also, if the insurance company states that the services are not billable (or what have you), and tell you to adjust to zero and issue no payment (and still state patient responsibility zero), you again would have to issue a refund to the patient.
    The only kind of "extra" charges you are allowed to charge a patient for is for returned/bounced checks, and if your office has a no-show policy that results in a charge.
    I TOTALLY agree with Augustine here.

    Jennifer L. Haney, CPC, CCC

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