99058-I am wondering

rthames052006

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Hello List,

I am wondering off the top of anyone's head if your being reimbursed for this code, at my new employer they bill alot of Emergency visits to the office and what they are doing is billing an e/m level lets say 99213 -25 , 99058.

I have a few rejections from some insurances that are bundling the 990588. I want to run a report on this code to see just how often it's billed and if it's reimbursed. But here everything goes thru the "corporate office" .

I will call them tomorrow to ask them how to run this report but I just wanted to know if anyone bills this code and if it is being reimbursed.
 

halebill

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Although this is a valid code, I haven't been able to find 99058 on any payer's fee schedule. If your practice/s regularly experiences disruptions in normal operations to tend to emergency situations, perhaps this an item that should be factored into the contract negotiations with your payers. I wouldn't count on Medicare ever paying it.
 

LOVE2CODE

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Hello List,

I am wondering off the top of anyone's head if your being reimbursed for this code, at my new employer they bill alot of Emergency visits to the office and what they are doing is billing an e/m level lets say 99213 -25 , 99058.

I have a few rejections from some insurances that are bundling the 990588. I want to run a report on this code to see just how often it's billed and if it's reimbursed. But here everything goes thru the "corporate office" .

I will call them tomorrow to ask them how to run this report but I just wanted to know if anyone bills this code and if it is being reimbursed.


United Healthcare (Medicaid), some Aetna's are paying our claims......I don't use a modifier though.....Every other insurance co's are stating it is a bundle code.....

YTH, CPC
 

scroney

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99058

united healthcare, cigna, bluecross, and aetna pay this code. medicare, presbyterian, tricare and any other government ins. do not. if the pt should have or would have gone to the ER and is urgently worked into the drs. schedule it can be used. the dr. must document that the pt was seen urgently. SC CPC
 

rthames052006

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United Healthcare (Medicaid), some Aetna's are paying our claims......I don't use a modifier though.....Every other insurance co's are stating it is a bundle code.....

YTH, CPC
Thanks Yolanda,

I was talking with the coding committee and they are going to be looking into this, some of them feel it's a waste of time.

I've been tracking some of the insurances like Blue cross, shield, coventry and am finding most of them bundle the service into the e/m.

I've been there almost 2 months now I will have to go back and check if they've been using a modifier on it, maybe thats the problem/issue.

Thanks for the advice
 

billie

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99058

We bill urgent care claims and bill the 99058 for every claim . Should we be using this code for our claims,?
 

kredd

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99058 in UC

According to David Stern, MD, CPC, board member of Urgent Care Association of America:

"99058 (emergent care) is a code that the AMA (CPT Assistant) does not feel should be used in urgent care centers, but emergencies in an urgent care center often cause even more disruption to patient flow than in a physician office. Thus, payors will often allow you to use this code (even in an urgent care center). It is a good idea to ask when you do negotiations."

see following link for reference:

http://www.ucaoa.org/phpBB3/viewtopic.php?f=8&t=339
 
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