CPT® Code 99026

1. Indications

The use of CPT® code 99026 is indicated in scenarios where a physician is mandated to be on call while present in the hospital. This typically applies to situations where the hospital requires the physician to be available for immediate response to patient care needs, emergencies, or other critical situations that may arise during their on-call hours. The following conditions may warrant the use of this code:

• Hospital Policy Requirement Physicians are required to be on call as per hospital regulations to ensure patient safety and timely medical intervention.
• Emergency Situations The physician must be available to address urgent medical needs that may arise unexpectedly during their on-call hours.
• Patient Care Needs The physician's presence is necessary to provide immediate care or consultation for patients admitted to the hospital.

2. Procedure

The procedure associated with CPT® code 99026 involves the following steps:

• Step 1: On-Call Requirement The physician is notified of their on-call requirement by the hospital administration, which outlines the specific hours they are expected to be available within the hospital premises.
• Step 2: Availability During the designated on-call hours, the physician must remain in the hospital, ready to respond to any patient care needs or emergencies that may arise. This includes being accessible for consultations, assessments, or interventions as necessary.
• Step 3: Documentation The physician must accurately document the hours spent on call in the hospital, ensuring that the time is recorded in compliance with hospital policies and coding guidelines. This documentation is crucial for billing purposes and to justify the use of code 99026.

3. Post-Procedure

After the on-call period has concluded, the physician may transition to other responsibilities or procedures as required. It is essential for the physician to maintain accurate records of their on-call hours for billing and compliance purposes. Additionally, any patient interactions or services provided during the on-call period should be documented separately, as they may be eligible for separate billing under appropriate CPT® codes. The physician should also review any follow-up care or consultations that may be necessary for patients they attended to during their on-call hours.