April 01, 2012
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Frank Navarro, Associate Director in CMA’s Center for Economic Services.
Are CPT codes 99000-99060 standalone codes?
No. According to AMA CPT Coding Guidelines, Special Services, codes, 99050-99060, are to be reported in addition to the basic service(s) provided.
Example: A physician receives a call at 1:00 a.m. from the parent of a child with fever, persistent cough, sharp pain in right ear and has been crying for five hours. The physician believes the child should be seen right away, but does not require the services of an emergency department. The physician agrees to meet the mother and child at her office in 30 minutes.
Physician bills: Appropriate E/M code and 99050 (for after hours service)
Note: Check with payors for their policy on payment of CPT codes 99050 – 99060. For example, some payors do not reimburse separately for CPT code 99053 (i.e., services provided between 10pm and 8am at a 24-hour facility) and consider it a surcharge which cannot be billed to the patient.