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Thread: 99051

  1. #1
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    Question 99051

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    I bill for a family practice that's open 6am-10pm, 7 day per week.
    When can I use the 99051? Can I use it after 5:30pm and on the weekends and holidays? How exactly does this code work?

    Thanks for any advice!
    Nicole

  2. #2
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    Default

    I use these codes over here in the practice I work for. It's for patients that walk in with no schedule appointment. You can use this during regular scheduled evening, weekend, or holiday office hours.

    But I recommend you collect this money up front. Instead of billing the insurance for this. Meaning for example, patients pay like $15 to $25 extra outside of there co-pay, for seeing them on a walk in service. Because insurance companies aren't paying this to often. Don't get me wrong I seen payment on these. Anywhere from $5.00 to $20. So it depend on you how your practice would like to apply these codes.

    Respectfully

    Daniel
    cpc

  3. #3
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    Thank you!
    Nicole

  4. #4

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    Can you actually collect the $$ upfront for this? If you are participating in the patients insurance company, I don't think this is correct. Also - The insurance companies should be paying this code as long as the documentation specifies the interrupted schedule.

  5. #5
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    This code is intended for those situations in which a physician agrees:

    -To stay after posted hours
    -Agrees to come in before posted hours
    -Agrees to come in on a weekend (not open during normal circumstances)
    -Agrees to come in on a holiday.

    As for reimbursement, this could become carrier specific. I would check with your carriers to determine who pays for this.

  6. #6
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    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

  7. #7
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    Daniel,

    Your opinion is duly noted. This forum is to bounce ideas off to one another for guidance and direction. Not all opinions are going to be 100% accurate. It is also my belief that proctors opinions also vary from person to person. Some information is hit and miss. There are revisions made to CPT constantly. It can be difficult to keep up with the on-going changes. When I provided my opinion, it was only that. This was the information provided to me when this cpt code was implemented. Doing further research, I see that there have been modifications to this code. Like everyone does, I learn something new everyday.

  8. #8

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    CPT code 99051 is for services that are provided in the office during regularly schedule evening, weekend, or holiday hours.

    CPT code 99050 is for services that are provided in the office other than regularly scheduled office hours, or days that the office is normally closed.

    I am not sure about collecting the extra money up front.

    Monika

  9. #9
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    Location
    Duluth, Minnesota
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    Quote Originally Posted by daniel View Post
    I use these codes over here in the practice I work for. It's for patients that walk in with no schedule appointment. You can use this during regular scheduled evening, weekend, or holiday office hours.

    But I recommend you collect this money up front. Instead of billing the insurance for this. Meaning for example, patients pay like $15 to $25 extra outside of there co-pay, for seeing them on a walk in service. Because insurance companies aren't paying this to often. Don't get me wrong I seen payment on these. Anywhere from $5.00 to $20. So it depend on you how your practice would like to apply these codes.

    Respectfully

    Daniel
    cpc
    Daniel, does that mean where you work - walk-ins are charged "more" than patients with an appointment?

  10. #10
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    Quote Originally Posted by nauger View Post
    I bill for a family practice that's open 6am-10pm, 7 day per week.
    When can I use the 99051? Can I use it after 5:30pm and on the weekends and holidays? How exactly does this code work?

    Thanks for any advice!
    Why would you want to use this code? I don't see any RVU's attached to the 99051. In my opinion I doubt very many insurances would reimburse separately for this code. Per CMS this would be bundled with payment for other services. (like the normal E/M). Most insurances are leaning towards following CMS guidelines. Where I work, walk-in's are coded/billed just like scheduled appointments, according to services provided and supporting documentation - why wouldn't they be? UNLESS it's an emergency. (that’s a whole different thing) We're open till 6:00pm also. No special codes attached to any E/Ms, even for the walk in's.
    I don’t read this code as specific to “patients who walk-in with no scheduled appointment”. I don’t see mention of such in the description.
    As for collecting payment up front -... I've never been to a medical facility that has made me pay for services up front other than my office co-pay (and more often than not they bill me for that even). And I’d be pretty upset if I was being charged “more” simply because I was walk-in!! At my facility, our sign says “walk-ins welcomed”!
    Donna

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