Cardiology Coding Alert

Question:  We recently hired a new physician who is questioning whether we can bill any extra codes for a walk-in established patient. He told us that his previous practice was able to collect for the office visit code and 99058. Is this accurate?

South Carolina Subscriber

Answer: The answer to your question depends on the circumstances and the payer. Some practices do collect for 99058 (Services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) when billed with office visits, but certain payers, including Medicare, do not price the code.

If the payer does cover 99058, you must meet the requirements described in the code. It is not just a walk-in code. Instead, 99058 indicates an encounter demanded the physician's immediate attention, therefore disrupting the schedule. The severity of the illness or the injury determines the appropriate use of the 99058 code.

In most practices, the staff members will triage the patient to determine if the condition is considered emergent. If it's determined to be non-emergent, they offer the patient the next available appointment. In that case, 99058 doesn't apply.

If the patient needs to be seen immediately, staff will disrupt the physician's schedule to ensure that the walk-in patient is seen. In these cases, you may consider reporting 99058 in addition to the basic service code.