CODING Q&A Additional Income from After-Hours Codes (99050, 99051, 99053) ■ DAVID STERN, MD, CPC Q . A patient with a finger laceration walked into our urgent care center at 8:05 p.m., five min- utes after our closing time. Rather than turn the patient away, our team decided to care for the patient. Three of our staff, including the physician, stayed for 50 minutes after our posted closing time. If we had not stayed after our scheduled closing time, the patient would have been forced to go to the hospital emergency department, where the services would have cost the insurer two to three times more. Is there a way for our center to receive compensation for providing this service—a cost-saver for the payor but a significant additional expense for our urgent care center? CPT code 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”) has been designated as a code for physicians to obtain reim- bursement for services rendered after regularly sched- uled office hours. A. Q . For code 99050, what determines whether a service is provided “after hours”? The key here is your posted hours. Make sure that your signage, brochures, and website clearly denote the hours of operation for your urgent care center. If the service begins during your posted hours, you should not use this code to denote caring for patients whose visits may last beyond the posted closing time of your clinic. A. David Stern is a partner in Physicians Immediate Care, with nine urgent care centers in Illinois and Oklahoma, and chief executive officer of Practice Velocity (www.prac- ticevelocity.com), a provider of charting, coding and billing software for urgent care. He may be contacted at dstern@practicevelocity.com. w w w. j u c m . c o m Q . We have a family practice that is open on Saturday mornings for scheduled appointments. Sometimes patients walk in during these hours, and the doctor will see them as an unscheduled, episodic visit. Since this is essentially an urgent care visit, would it be appropriate to code with 99050? No. Since the patient is being seen when the office is normally open, you should not use code 99050. Some payors, however, may reimburse for code 99051 (“Ser- vice(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service”). A. Q . Our urgent care center provides services on evenings, weekends and holidays—including Christmas and New Years Day. We have to pay our staff time-and-a-half to work holidays. To hire and retain staff to work these extended hours, we need to pay more than a typical (9 a.m. to 5 p.m., Monday through Friday) fam- ily practice. Is there any code to use to get compensated for provid- ing extended hours services and incurring these addi- tional costs? CPT code 99051 was designed to compensate your practice for these additional costs. Never use this code for Medicare. Some other payors will not reimburse you for this code, so you may want to check the policy of each of your payors. A. Q . A. At what time does “evening” start? Most consultants consider it appropriate to start using this code after 5 p.m. on weekdays. If you are unsure, check with your local payors. Q . If I code with 99050 or 99051, does this replace the evaluation and management (E/M) code or an- JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a y 2 0 0 7 41