Services at Other than Regularly Scheduled Office Hours

Problem

Leaving money on the table for services that are performed after hours and at other special times.

From a CPT coding perspective there are special adjunctive codes that are used in addition to the basic service(s). This code series ranges from 99000 to 99099.

Within this series are important codes that deal with special service situations. These codes include services at "other than regularly scheduled" office times.

In a recent BCBS news article in one state they made reference to making payment for these codes. It is good to see that payers are using these codes that fully describe and pay for an encounter.

Findings

The following CPT codes could apply to many chiropractic office encounters that might not have been previously considered and used:

  • 99050 Services provided in the office at times other than the regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to the basic service.
  • 99051 Services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to the basic service.
  • 99058 Services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to the basic service.

Assessment

Regarding 99050: When an appointment happens under its description, the use of this code is appropriate. Examples: the office is open at 9 am, but a patient needs to be seen at 8 am; the office closes at 5 pm, but a patient wants to be seen 6 pm. Obviously, this inconvenience and special scheduling has an intrinsic value. Such a value is expressed in this code. Wisdom is needed for practical application. Candidly, an appointment five minutes before or after scheduled hours would probably not be appropriate. Apply the law of the Golden Rule (how would you like to be treated?).

Regarding 99051: Some offices/clinics might schedule special hours for evenings, weekends, or holiday hours. Accordingly, such occasions might require special "overtime pay" or other incurred costs. The use of this code could then be most appropriate.

Regarding 99058: The focus is not upon the emergency status but upon the impact of the disruption. If the office is fully scheduled and a real "emergency" needs immediate attention, there could be a significant disruption. Sometimes it might be a great inconvenience to the scheduled patients. Interestingly, one clinic recently offered the collected fee for 99058 to the other scheduled patients for their inconvenience. Do not use 99281 or 99282 which are codes for bonified Emergency Departments, usually in hospitals.

Regarding fees: If a fee is to be charged for such occasions, it is a personal decision by each provider. There are no national RVUs for these codes, so each office needs to make its own evaluation for the fee amount.

Recommendation/Plan

When patients are seen at unusual or special occasions:

  1. Use the adjunctive code that accurately expresses the event.
  2. Determine if a fee is appropriate; and if so, how much.
  3. Communicate the fee amount with the patient before the encounter.
  4. Stay alert to reimbursement policies by specific payers.