Extended office hours require different billing

July 18, 2008

How do I bill for service during extended office hours?

Key Points

We recently decided to stay open until 7 p.m. on weekdays and to add Saturday hours and emergency hours on Sunday. Staffing for the extended hours isn't a problem, but coding is: A consultant advised us to report 99050, the code for service provided in the office at times other than regularly scheduled office hours or days when the office is normally closed. Since these are now our normal hours, we don't think this is correct. Who's right?

You are. Since you've expanded your hours, it would be inappropriate to bill 99050 for anything other than times during which your office is closed (it could be later on Saturday or Sunday). Code 99051-service provided in the office during regularly scheduled evening, weekend or holiday office hours, in addition to basic service-would be a more appropriate charge. Or, if an emergency patient is brought in during regular hours and must be seen before your regularly scheduled patients, the correct code would be 99058-service provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service. Unfortunately, most insurers will bundle these services and pay only for the basic service provided.