Proper Use of Afterhours Codes in Your Medical Billing

If an ob-gyn is called to the office at midnight to see a patient for an after-hours ob check, using the proper coding designation will make or break your medical billing claim.

First of all, take in to consideration the location. If the care was provided at a 24-hour facility, you will want to use CPT after-hours code 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed …). Do not use codes 99052-99054.

The old way of reporting this scenario was that CPT used to look at these type of claims based on time and day. The code that described the hour or day of week when the ob-gyn provided the service.

A good example is if an ob-gyn provided late-night services, you used 99052 (Services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service). For services that he performed on a holiday or on a Sunday, you used 99054 (Services requested on Sundays and holidays in addition to basic service).

The new way to report this designation is to address the late-night service code 99053 (Service[s] provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service), to 24-hour facilities. CPT 2006 deleted 99052 and 99054, which leaves offices with two possible after-hours codes:

* 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 addition to basic service

* 99051 –Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

You should not use an emergency-service code. CPT 2006 clarifies that an emergency must disrupt other scheduled office services.

Make sure that you have the proper documentation to show the medical necessity of your claim and you will realize better reimbursements on your medical billing.

View all Articles by: Melissa Clark, CCS-P