Codes physicians likely aren’t using … but should

Doctors are always on the lookout for ways to maximize reimbursements. I would like to shed some light on a few codes that I find are often misunderstood or underused. By knowing these codes, practices can earn additional reimbursement.

Current Procedural Terminology (CPT) contains listings for “Miscellaneous Medicine Services,” which consist of a number of underutilized procedure codes. 

All of these codes are meant to be billed along with the basic service (in other words, don’t bill these alone), and they offer additional reimbursement for the resources and complexity involved in these encounters. As always, you should check with payer policies regarding these services. Some may not cover them; others may require certain criteria to show the medical necessity of the service.

 99050 

Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g, holidays, Saturday or Sunday).

In this code, the physician renders services to a patient at the office at a time when that office  is normally closed. This code should not be used to report an encounter when the provider’s office hours are extended beyond normal hours to accommodate patients who have not yet been seen, such as when a provider is running late. This can be billed for scheduled or unscheduled patients, so long as the service is furnished at a time when the office would not normally be seeing patients. Providers should post their office hours in the waiting area and preferably online to prove that you are correctly billing this service.

 99051 

Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours.

Unlike 99050, this code can be billed when the provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend or on a holiday. The difference between 99050 and 99051 is whether the office is normally open during those hours. For example, your office may be regularly open on Saturdays, or you may have special extended seasonal hours. In either of these cases, use 99051, not 99050.  Check with your local payers to determine their definition of “evening” hours. Some insurers define this to mean services provided before 8 a.m. and after 6 p.m., while others may count services after 5 p.m. to be evening hours.

 99058 

Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services.

This code can be used when a patient is seen in the office urgently, without an appointment and ahead of other scheduled patients. There are two key points here. First, the patient should have an emergency that demands immediate medical attention. Not every walk-in patient automatically qualifies. There should be an urgent, acute or sudden problem that prompts the patient to be seen as soon as possible. Second, it must disrupt other scheduled services. If other appointments were not impacted, this code should not be reported. Try to include these two factors in the narrative of the documentation for the encounter to be sure proper credit is given.

 99053 

Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility.

Not many providers know about this code. It is very specific, but whenever a provider sees a patient during nighttime hours at a 24-hour facility (such as an urgent care center or emergency department,) this code may be billed in addition to the basic E/M service. Because the code descriptor gives the specific time(s) allowable, the provider must clearly state the encounter time in the documentation.

If you have questions about these codes, or suggestions for other underutilized codes you would like to see discussed in a future article, please contact us at medec@ubm.com.