Questions for Dr. Stern
About Your Urgent Care Center
24. I had been doing some research on the use of Code 99051 and then I opened the most recent Journal Of Urgent Care Medicine. The Q&A on "Additional Income" was very helpful. I do have a couple of questions concerning the use of Code 99051 that I am hoping you may be willing to help me with.
- For evening hours, how does a payor know if a visit occurs at 7pm at night or 10 am in the morning? Do we have to somehow "time stamp" a claim?
- I have heard that in our market certain payors will not reimburse for Code 99051 (specifically United/Medicare). Is it wrong to automatically not put Code 99051 on claims for those payors or should we consistently use of the code for all payors no matter what?
- Our providers are struggling with the philosophical issue of adding additional cost to a visit when it is a deductible situation. They get the fact that it costs us more to operate in the evenings/weekends, but they struggle with passing more cost to the patient. Any thoughts?
Thank you for your questions. Here are my responses.
- I have never seen a payor require this proof. However, the medical record should clearly document the time of service if it is ever contested.
- You should never put this code on Medicare claims. It is fine to omit this code when this is agreed to between the UCC and the MCO.
- Would they prefer to take a pay cut to make up for the additional costs? Maybe simply agreeing on a reasonable fee would make sense. Of course, you can not discriminate on the basis of whether the patient is in a deductible or not.
