Using the right after-hours code; coding an anxious patient's blood test
Answers to your questions about . . .
Q:I was treating a jaundiced newborn and received the lab results from the serum bilirubin at about 10:30 pm, past regular office hours. I met the child at the hospital an hour later and spent 90 minutes examining him, reassuring the parents, and waiting for more lab results. I sent the baby home and arranged for home phototherapy. We charged a code for an emergency department visit. Can we also charge an after-hours code (99050-99054)?
A: Yes. The after-hours codes are adjunct codes, meaning they are used in addition to codes for other procedures or services the physician performs. For your case, report the appropriate emergency department code (99281-99285) with 99052 (services requested between 10 pm and 8 am in addition to basic service).
If the same situation occurred on a Sunday or holiday, you could bill both codes above and 99054 (services requested on Sundays and holidays in addition to basic service).
Code 99050 (services requested after office hours in addition to basic service) would most commonly be used as an adjunct to services provided after a physician office's normal hours but outside the 10 pm to 8 am window covered by 99052 and the Sundays/holidays window covered by 99054.
For example, at 5 pm on Friday, as the office is getting ready to close, a patient asks if he can be seen that day for a certain condition. He can be there in 30 minutes. Rather than refer the patient to the ED, the physician sees the patient at 5:30 pm. He can bill an E&M service with 99050 to indicate that the service was after normal office hours.
Medicare doesn't pay separately for the after-hours codes. Medicare considers payment for these codes to be bundled into the payment for the basic code in each circumstance. However, some private payers reimburse for the after-hours codes, and you should bill them whenever appropriate.
Q: A patient presented with complaints of anxiety. Because the patient takes imipramine, I ordered a blood test to check the blood level. Should I use the diagnosis code for anxiety, or the V code for long-term medication use?
A: You should bill both codes. Because anxiety is the initial complaint and the reason you ordered the blood test, report 300.00 (anxiety state, unspecified) as the primary diagnosis code.
You ordered the test to make sure the patient's medication isn't affecting his blood level, so use V58.69 (long-term [current] use of other medications) as the secondary code. The anxiety diagnosis supports the reason for the office visit, while the V code supports the medical necessity for the lab work.
Also report the V code for the cause of the anxiety from the V60 seriesfor instance, V62.89 (other psychological or physical stress, not elsewhere classified, other).
All three diagnosis codes would be used with the appropriate E&M visit code. On the claim form, list 300.00 first, the appropriate code from the V60 series second, and V58.69 last.
Not all carriers pay the anxiety diagnosis code, but most will reimburse for the V60 series code. If the carrier denies both, it will pay for the test, but not for the office visit.
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Coding Consult. Medical Economics 2002;8:19.