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Afterhours Clinic and Use of 99051

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Afterhours Clinic and Use of 99051
    Medical Coding Books
    We have an afterhours clinc that we are starting soon that will be staffed by an FNP. The clinic will be open two days nights a week from 5p.m. -9 p.m. and on Saturdays from 9 a.m. - 1p.m. The evening hours are outside of our normal office hours that are Mon-Fri from 8 a.m. -5p.m.

    Since this is an afterhours clinic, would or could we use 99051 (service(s) provided in the office during regulary scheduled evening, weekend, or holiday office hours, in addition to basic service)?

    What is the correct use of 99051 and when would you use it? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
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    Quote Originally Posted by dballard2004 View Post
    We have an afterhours clinc that we are starting soon that will be staffed by an FNP. The clinic will be open two days nights a week from 5p.m. -9 p.m. and on Saturdays from 9 a.m. - 1p.m. The evening hours are outside of our normal office hours that are Mon-Fri from 8 a.m. -5p.m.

    Since this is an afterhours clinic, would or could we use 99051 (service(s) provided in the office during regulary scheduled evening, weekend, or holiday office hours, in addition to basic service)?

    What is the correct use of 99051 and when would you use it? Thanks.
    Dawson,
    Our local BCBS advised the use of 99050. I specifically asked about 99051 and gave your exact scenario they said no. To them, 99050 is used based on their hours of operation - before 8 am & after 5 pm Monday - Friday.

    Hope that helps.

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks so very much for the feedback. I appreciate your insight. I was thinking along those same lines as well but was needing a second opinion.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Default
    Dawson,
    I would proceed carefully here... If your hours are posted then 99051 would apply and to use 99050 would be risky. True, some commercial carriers do not pay out for 99051 ( I am in NC and our BCBS pays for this code... as well as Medcost, PHCS, Cigna, First Health, Aetna and a few others.... even NC Medicaid pays.... our only hold out is United Healthcare)

    Having said that... you should always code based on the CPT guidelines. If a specific carrier tells you that 99051 is not a covered charge then I would fight with them the next time you are negotiating contracts (citing the OT you have to pay your clinical staff and additional overhead to keep your doors open extended hours in order to keep your patients out of the emergency room) but I would not recommend using 99050 to inaccurately report the services being provided.

    Just my opinion... hope it helps!
    Last edited by bhaskins1; 10-22-2008 at 02:35 PM. Reason: spelling... again!
    Barbara Haskins CPC

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks so very much! I appreciate your insight.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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