Q&A 99050

[Cathy]

What modifier would you used for an E/M service along with 99050?

 

[Laureen]

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

Hi Cathy,

I don't think you would need a modifier for this. Have you tried billing an EM with this code and are getting a denial?

 

[Melanie Bleem]

Hi Ladies: I hope this bumps this conversation. We've been seeing a few Chiropractic people after hours for emergencies and when we get our ERA's back from BCBSIL they deny the 99050 as "not paid separately". I've called them and they said they don't know if it's just not covered of if we are billing incorrectly. I've searched news on this and it all says you should code the "after hours" call WITH the service being performed. In this case a 98940 (CMT 1-2 regions). In our case, we billed a 99212-25 (Established pat exam), a 99050 (after hours), and a 98940 (CMT 1-2 regions). The question would be, do I need to do anything else or am I dealing with a medical review policy issue? It may be closer to Policy since they are saying we can't bill the patient. I don't care if they pay or apply it to deductible. I would like to be able to charge the patient for it. In this case, we cannot due to our contract with BCBSIL. Thoughts?

 

[Laureen]

Per this document I think they are considering the CMT codes as preventative.

https://www.empireblue.com/provider/noapplication/f5/s4/t0/pw_b157666.pdf?refer=ehpprovider

You may need to appeal and provide documentation why it was an emergency.

 

[Melanie Bleem]

Thanks for your thoughts. We typically don't have issue with the 98940 (CMT) but rather the 99050 After hours night call. I did hear back from our Rep and here is his response. It's good for us to remember that we may need to get a waiver from the patient and bill them directly. Somehow I wish they could tell us this before we bill. *sigh*

If you bill after hours charges to BCBSIL, we will not allow you to bill the patient. You best is to let the patient know about the service fee up front and have them sign a waiver acknowledging that it is not eligible for reimbursement. They will need to understand why it will not be filed to the insurance company.

Thanks again!

 

[Paul A]

I'm not familiar with any plans that actually pay for the after hours codes. You actually need to know in advance before you see the patient about the waiver. Unless Blue cross is different, or the rep is misinterpreting the policy, there is usually a hold harmless clause in every contract. You typically cannot bill the patient for any non-covered services unless you notify them in advance of non-coverage.

If it were the insurance company i work for and the patient complains about getting billed for the charge (whether or not you have submitted it) we will ask for a copy of the waiver and if you don't have it, you need to stop billing the patient.

 

[Melanie Bleem]

Agreed and that is our understanding too. We always have patients sign the ABN (not the Medicare one) or waiver for any services non covered or experimental by a policy. We don't typically bill the insurance either. (we are not required to do so and the patient is told as such) We've learned the hard way over the years to always warn the patient in advance and have them sign. Thankfully we don't have a ton of After hours calls so that code was not one we routinely use. Thanks for your input.