How To Use CPT Code 99051

CPT 99051 refers to services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 99051 procedures.

1. What is CPT 99051?

CPT 99051 is a code used to bill for services provided by healthcare professionals during regularly scheduled evening, weekend, or holiday office hours. This code is billed in addition to the basic service provided, such as evaluation and management (E/M) services. It is essential for medical coders and billers to understand the appropriate usage and documentation requirements for this code to ensure accurate billing and reimbursement.

2. 99051 CPT code description

The official description of CPT code 99051 is: “Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.”

3. Procedure

1. The healthcare provider schedules an appointment with the patient during regularly scheduled evening, weekend, or holiday office hours.
2. The provider performs the necessary evaluation and management services during the appointment.
3. Medical coders and billers document the services provided and the circumstances under which they were rendered, including the fact that the appointment took place during non-traditional office hours.
4. CPT code 99051 is billed in addition to the appropriate E/M code that describes the services rendered.

4. Qualifying circumstances

Patients who receive services during regularly scheduled evening, weekend, or holiday office hours are eligible for CPT code 99051. This code is not intended for use when the office changes its hours temporarily to accommodate seasonal needs, such as during flu season. In such cases, CPT code 99050 should be used instead.

5. When to use CPT code 99051

CPT code 99051 should be used when a healthcare provider sees a patient and provides services during regularly scheduled evening, weekend, or holiday office hours. This code is billed in addition to the appropriate E/M code that describes the services rendered. It is important to ensure that the services provided meet the criteria for CPT code 99051 and that proper documentation is maintained to support the claim.

6. Documentation requirements

To support a claim for CPT 99051, the following information should be documented:

• Date and time of the appointment
• Services provided during the appointment
• Confirmation that the appointment took place during regularly scheduled evening, weekend, or holiday office hours
• Any additional information that supports the use of CPT code 99051, such as the reason for the appointment or the patient’s medical condition

7. Billing guidelines

When billing for CPT code 99051, it is essential to follow the appropriate guidelines and rules. This code should be reported in addition to the appropriate E/M code that describes the services rendered. It is also crucial to check with major insurers’ payment policies on special services codes, as some payers may only reimburse for special services when the patient’s condition requires urgent care. Proper documentation is necessary to support the claim and ensure accurate billing and reimbursement.

8. Historical information

CPT 99051 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Similar codes to CPT 99051

Five similar codes to CPT 99051 and how they differ are:

1. CPT 99050: This code is used for services provided in the office at times other than regularly scheduled office hours or days when the office is normally closed. It is intended for circumstances when patient-requested care is outside the usual timeframe of routine scheduling.
2. CPT 99058: This code is used when a healthcare provider sees a patient on an emergency basis in the office, interrupting other scheduled appointments. It is billed in addition to the appropriate E/M code.
3. CPT 99060: This code is used when a healthcare provider sees a patient outside of the office, such as at the patient’s home, during regularly scheduled evening, weekend, or holiday office hours. It is billed in addition to the appropriate E/M code.
4. CPT 99070: This code is used for supplies and materials provided by the physician over and above those usually included with the office visit or other services rendered.
5. CPT 99075: This code is used for medical testimony provided by a healthcare provider, such as in a legal proceeding or deposition.

10. Examples

Here are 10 detailed examples of CPT code 99051 procedures:

1. A patient visits their primary care physician for a routine check-up during regularly scheduled Saturday office hours.
2. A patient with a chronic condition requires a follow-up appointment with their specialist, which takes place on a holiday during regularly scheduled office hours.
3. A pediatrician sees a child for a well-child visit during regularly scheduled evening office hours.
4. A patient visits their healthcare provider for a flu shot during regularly scheduled weekend office hours.
5. A patient with diabetes has a scheduled appointment with their endocrinologist during regularly scheduled evening office hours for a medication adjustment.
6. A patient visits their healthcare provider for a pre-operative evaluation during regularly scheduled weekend office hours.
7. A patient with hypertension has a follow-up appointment with their cardiologist during regularly scheduled holiday office hours.
8. A patient visits their healthcare provider for a minor injury during regularly scheduled evening office hours.
9. A patient with a respiratory infection sees their healthcare provider for an evaluation during regularly scheduled weekend office hours.
10. A patient visits their healthcare provider for a post-operative follow-up appointment during regularly scheduled holiday office hours.