• Ocular Trauma: Submit Your Additional Exam Codes

    A sense of urgency washes over a practice when an ocular trauma patient comes in for emergency treatment.

    Physicians train staff to stay calm, document details of how the trauma happened and research payer responsibility. The physicians may need to provide immediate surgery depending on the type of injury. These services are never planned and can disrupt a full schedule or require assistance on the weekend.

    To try and alleviate the burden of adding on patients to already full schedules, some commercial payers allow for additional CPT codes to be submitted along with exam codes, reimbursing physicians for services performed in emergency situations. Be sure you are adding them to your claims when appropriate.  

    The two most commonly used add-on codes are:

    • 99050 Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed, (e.g., holidays, Saturday or Sunday), in addition to basic service
    • 99058 Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service

    These codes were published in 1993 to accommodate workers compensation patients. They can be submitted with either evaluation and management (E/M) or eye visit code exam codes. Although Medicare Part B and Medicaid will not allow for additional reimbursement, some commercial payers have a set fee as it may be more cost effective to have the patient see the ophthalmologist, rather than seek help through urgent care or emergency facility. Not all commercial payers will allow the add-on codes. They may bundle them into the exam codes like Medicare or state the patient may be responsible.

    Other additional CPT add-on codes include:

    • 99051 Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service
    • 99053 Service(s) provided between 10 p.m. and 8 a.m.
    • 99056 Service(s) typically provided in the office, provided out of the office at request of patients, in addition to basic service
    • 99060 Service(s) provided on an emergency basis, out of office, which disrupts other scheduled office services, in addition to basic service

    These codes are less common and may not have an allowable. Consider reaching out to your payer representative for additional guidelines should these codes be necessary. They may be able to assist with the allowable.

    An Important modifier to include:

    • -57: An evaluation and management service that resulted in the initial decision to perform surgery

    The Academy now has a coding ocular trauma webpage designed to help walk physicians and staff through trauma practice preparedness and case study examples. See a case example of using the add-on codes for corneal laceration

    About the author: Jenny Edgar, CPC, CPCO, OCS, is an Academy coding specialist. She is also a contributing author to the Academy’s Ophthalmic Coding Coach and Ophthalmic Coding series.