Fam Pract Manag. 2002 Apr;9(4):19.
After-hours codes in the ED
I share call to cover the local rural emergency department (ED), and I submit evaluation and management (E/M) codes for my ED care. Could I also submit “after-hours” codes (e.g., 99052 and 99054) for the ED visits that occur after my regular office hours?
There are two schools of thought on this question. The after-hours codes were intended to be reported by office-based practices whose posted hours did not include 10 p.m. through 8 a.m. or Sundays and holidays. However, CPT does not restrict the reporting of codes 99052 and 99054 by any specialty group, including emergency physicians. As stated in CPT, “Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional.” Thus, one school of thought, which includes the AMA, says you can submit the after-hours codes in conjunction with the typical E/M codes for emergency care. However, the other school of thought notes that by CPT definition, an emergency department is “an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.” This would seem to eliminate the use of after-hours codes.
Each third-party payer may have specific reporting and reimbursement policies that govern the reporting of this series of codes. You should check with the payers in your area to determine the local practice of reporting after-hours services. You will probably find that most payers do not reimburse these codes in conjunction with emergency department services codes 99281–99285 since the emergency department is a 24-hour facility.
ICD-9 codes for newborn visits
Our practice often sees newborns in the office three to four days after they’ve been discharged from the hospital to check on breast-feeding, etc. This is usually a brief, problem-free visit. What ICD-9 code should we submit for it?
Consider submitting V20.2, “Routine infant or child health check,” or V20.1, “Other healthy infant or child receiving care.” If low birth weight is an issue, you may also want to consider one of the low birth weight status codes (V21.30-V21.35).
For an intramuscular injection, can I submit the injectable material code and the intramuscular/subcutaneous injection administration code?
Yes, you can submit codes for the injectable product and its administration when codes exist for both. For example, in the case of immune globulins, CPT states that the product-only code (e.g., 90281, “Immune globulin (Ig), human, for intramuscular use”) should be reported in addition to the appropriate administration code (e.g., 90782, “Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular”). Similarly, CPT provides separate codes for vaccine/toxoid administration that should be submitted in addition to the codes for the vaccine/toxoid products themselves.
If there are no specific CPT codes to describe the injectable product, you can report the appropriate HCPCS J code or CPT code 99070 “Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided).” For 99070, most payers require that the supply be described, and some require that an invoice be attached to the claim. Also keep in mind that some payers will not reimburse for the administration if it’s reported in addition to an E/M service.
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management.
Conflicts of interest: none reported.
These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Marie Felger, CPC; Thomas A. Felger, MD, ABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Hill, PA-C; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC.
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Copyright © 2002 by the American Academy of Family Physicians.
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