Medical Billing Forum

Coding => Coding => Topic started by: midwifebiller on August 27, 2010, 10:14:18 AM

Title: 99050
Post by: midwifebiller on August 27, 2010, 10:14:18 AM
A pregnant woman sees the midwife after-hours for a routine antenatal (AP) visit.  Since the AP visit is included in the global OB code, we do not submit a claim for the visit.  However, 99050 (after hours or Sun/Holiday) is an add-on code, and when we submit this code without an E/M code, it is denied, even with a note in Box 19.  Should we submit an E/M code for the AP visit with $0 due in addition to the 99050?

Thank you.
Title: Re: 99050
Post by: oneround on August 27, 2010, 11:28:27 AM
Because this is and add on code it cannot be reported alone.  Add on codes must be reported in conjunction with the code for services performed.

When reporting the misc. CPT codes such as 99050, there is no additional modifiers per CPT guidelines. The reimbursement of these misc. codes are carrier specific.  I believe that medicare does not pay for this code.
Title: Re: 99050
Post by: midwifebiller on August 27, 2010, 01:12:07 PM
Thank you for your reply.  I understand 99050 is an add-on code and should not be reported alone.  But the AP visit is included in the global fee and should not be reported separately.  Most carriers that we deal with reimburse for after-hours care and we are routinely reimbursed for 99050 when attached to a problem visit.  (We have never billed Medicare--not many women over age 65 are having babies.) We would like to be able to capture this extra reimbursement for our midwives when they see a client/patient for a routine AP visit after hours.   From your email, it sounds like we could submit a 99213 with $0 due and then add on the 99050 with its fee.  Am I understanding correctly?

Thank you.
Title: Re: 99050
Post by: oneround on August 27, 2010, 01:42:33 PM
You got me on that medicare one, typical male I am but hey it's 2010 anyone can have a baby nowadays.  lol. 

Yes you can bill the E/M with the Ah code for problem visits afterhours but my one question is why are the pt's coming in after hours for routine AP care?  Are your pt's high risk? I  am in total agreement when you state that the E/M would be part of the global package but before I give my thought on that AH code  being attached I would like to know what is promting the afterhours visit?
Title: Re: 99050
Post by: midwifebiller on August 27, 2010, 05:37:10 PM
Usually it's a scheduling problem. For example, Hubby wants to come to a visit with his wife and ask the midwife questions, be there for the ultrasound, etc., but doesn't get off work until 7:00 pm. So the midwife will agree to see them in the evening for that visit.  Or maybe it's the client/patient herself who has to work overtime that month and can't get off until late.  Most of our midwives have evening hours once or twice a week, but every once in awhile we get a superbill with an after hours charge for a routine AP visit.

Your insight is appreciated.
Title: Re: 99050
Post by: DMK on August 30, 2010, 10:52:09 AM
You may still want to inquire about what Medicare would pay if the occasion arose.  More and more people with other problems are getting Medicare in their younger years.  We have several 20's and 30's people who are "disabled" (don't get me started) and have Medicare.
Title: Re: 99050
Post by: midwifebiller on August 30, 2010, 11:03:24 PM
True, true, and I'm sure you've got a large soapbox under your office desk concerning the whole Medicare and "disabled" status.  :-)

Medicare will not reimburse a Licensed Midwife, only a Certified Nurse Midwife (and most CNMs work in a hospital and do not need a billing service).  We do keep tabs on what Medicare pays and how much, however, simply because other carriers always seem to pattern their rates and covered services after them, if not their provider types.
Title: Re: 99050
Post by: midwifebiller on August 31, 2010, 08:02:05 PM
Oneround--do you have any opinions on this?

Title: Re: 99050
Post by: oneround on September 02, 2010, 11:19:52 AM
I'll pull some doc's on this and review what I find.  All of our MW's in our facilities are CNM's.     I'm going to run a report on mid's at our clinincs just to see what I come up with.  As for the AH coding I checked with our OBGYN coders to see if our clinics are encountering the same things for pt's and so far I am only getting that the pt;s are coming in UC for problems and not routine care.  I'll run another report on that just to see if I can capture something.  To me it just seems a odd, but I'm not the pro when it comes to billing.  I'm curious to here form others on this to see their opinions.
Title: Re: 99050
Post by: midwifebiller on September 15, 2010, 09:12:32 PM
I would like to hear from others, as well.  What is the best way to bill for after-hours services (add-on 99050) when the office visit itself is part of the global fee?