Coding Professional Services Provided During Nontraditional Days and Times
Single path coding allows one coder to handle both facility and professional coding for the same patient encounter. When a facility owns and operates an Outpatient Clinic or Urgent Care Center that is open on weekends or holidays, the Single Path Coder needs to know if and/or when to report the following codes for professional services:
99050: Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, 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
99053: Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service.
Medicare does not reimburse facilities or professionals for CPT codes 99050, 99051, and 99053. However, some commercial payors will reimburse professionals for one or more of these codes. Because commercial payment policies vary, Single Path Coders need to have access to the payment policies for these three codes.
For example, a facility might research their commercial payment policies and create a spreadsheet to easily communicate the policies:
| Holiday | Commercial Payer A | Commercial Payer B | Commercial Payer C |
|---|---|---|---|
| New Year’s Day | 99050 | ||
| Dr. Martin Luther King, Jr. Day | |||
| President’s Day | |||
| Memorial Day | |||
| Juneteenth | |||
| Independence Day | 99050 | ||
| Labor Day | |||
| Columbus Day | |||
| Veterans Day | |||
| Thanksgiving | 99050 | ||
| Christmas | 99050 |
Since commercial payment policies may change from one year to the next, it’s also important to annually re-review the payment policies for CPT codes 99050, 99051, and 99053.
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