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Billing After Hours

  1. #1
    Default Billing After Hours
    Medical Coding Books
    Good morning,

    I work for a small family practice and one of our physicians has started to see patients after our normal business hours which we are open 8-5 and I was wondering if we are able to bill the 99050 along with the office visit? I guess were I am confused is if the 99050
    is billed only if the patients are seen for emergency services after hours? If someone can help me understand my confusion.



  2. #2
    I have always felt that it is when a patient requests to be seen during after hours and found this:
    Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service.
    Hope this helps!

  3. #3
    I have done billing for Internal Med and an Urgent Center at our location and this issue has come up many times. The rules we follow are
    99050 - Hours beyond normal scheduled hours.
    99051 - Hours that are scheduled for the weekends, holidays, etc.
    99058 - An emergency visit during normal scheduled hours.

    I do feel that in your example if your office is normaly scheduled to be closed at the time of the patients visit billing 99050 is appropriate. However, we found that a lot of the insurances adjusted this charge off. You may want to check with your local carriers.
    Stephanie Livingston, CPC

  4. #4
    Milwaukee WI
    Default On the other hand
    On the other hand .... if this physician has decided that he will "stay open until 8p" on - for example - Thursdays to accommodate patients who can't get off work early, then he has, in effect, changed his office hours and the 99050 code would NOT apply.

    Also, be sure you understand that very few insurance companies will recognize and pay for these special codes. Make a decision in advance how you will handle that - write it off, or ask the patient to pay? (This may partly be a function of your contract with insurance and the reason for "denial," so read those EOBs carefully.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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