Healthcare provider has never been an easy profession. Nationwide, hundreds of thousands of medical specialists risk their lives to treat patients in these extraordinary times. Many of you value your patients’ health & satisfaction over everything else. Dear doctors, you are our genuine superheroes in white capes!
Today we would like to guide you through an issue that has been familiar to many healthcare providers regardless of their specialty, location, and experience. Namely, providing care to patients outside of your regular schedule and getting a proper payment for it. Imagine a patient who is experiencing a significant health crisis on Sunday night, desperately needing your help.
Despite the fact that it is a weekend, and you may be having barbeques with your family at that time, you still go to your office and provider top-quality care to the patient in need. After the service has been performed, you document the encounter and submit a claim for it to a payer. This is where the challenge begins.
Some healthcare professionals and medical billers believe that an office visit performed after regular work hours should be reported & billed as if it was a regular, scheduled encounter with no indication whatsoever. This is wrong. Adherence to such a billing pattern leads to claim underpayments.
The fact that a service has been performed outside of the normal schedule of your office have to be clearly indicated on your claims. There are several CPT codes that you can use to indicate that you have performed a certain procedure outside of your regular schedule. However, it is critical to remember that none of them are payable if billed without the main procedure code. The most used CPT codes are the following:
99050 - services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed, in addition to basic service
99051 - services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service
For example, one may bill an office visit procedure code 99213 (basic service) along with 99050 (supplemental service indicating a shift from a general schedule).
Coverage of these two procedure codes strictly depends on a patient’s benefit plan.