After Hours Codes Update (99050, 99051, 99058)

In days of yore, I wrote about the pediatric usage of the 9905X CPT codes, often known as the “after hours” codes.  In fact, I think my explanation here about how they should be used is still good (corrections, suggestions welcomed).  Just before the holiday break, a request for updated data came through SOAPM – and the last data I shared is more than 5 years old, so let’s see what’s changed.

CPT Code Average Charge Average Payment Average Payment, 2007
99050 $43.63 $20.47 $19.95
99051 $45.81 $8.58 $7.20
99058 $88.74 $8.86 $15.60

Before I begin my commentary, I should make clear to any FTC overlords that this data is from a large national sample of non-competing practices from a period of time more than 3 months ago, etc., etc., etc. The idea of these practices restraining trade is laughable, as evidenced by above.

Anyway, what do we see?  Payments have generally held steady with mild improvement for the most common codes (99050 and 99051) but the payment for 99058 has plummeted.  My guess as to why?  We’ve got a much bigger sample than we had in 2006/2007 and I think the use of the code has increased, which woke the payers up to the assumption that it’s being misused and not giving credit for it.  In other words, when you get practices who bill a few hundred “emergency” visit codes a year, it devalues that particular code for others.  Just my guess.

Another thing that comes through the new data is the increased use of the codes in general.  I didn’t have the time this week to figure out what percentage of visits carries an after-hours code, but it has clearly increased.  When you see those kids on weekends, on holidays, or after 5 or 6pm, it’s time to get those codes on there and get recognized for your additional value.

I hope this helps those on SOAPM who asked for it – let me know if you need more.  And thanks to Igor for his fine data collection work.

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