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Pediatric Coding Alert

Reader Questions:

Back Up 99058 With Adequate Documentation

Published on Thu Apr 01, 2010

Question: Our pediatrician wants to start billing 99058 when an emergency interrupts other scheduled services. Can you offer guidance for reporting 99058 with an E/M code or modifiers? Maryland SubscriberAnswer: Many insurers reimburse for 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service), but keep a few things in mind before reporting the code.The patient must present and disrupt normal scheduling. For example, a mother brings in her son because of an acute asthma attack. If your schedule is full but you promptly take him to an exam room, this service qualifies for 99058. If you saw him right away but had an opening in the schedule, you wouldn't report 99058. Needing to see the child right away can also apply when the phone staff tells parents who call your office to bring the child in as soon [...]
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