after hours code 99053

dpage77

Guest
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10
Location
buffalo
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I am interested to find out if anyone is billing for this code and if they are being reimbursed. We have a few carriers that have stated they allow for this code, but sometimes the claims are bundled. When we send for an appeal, we add modifier 25 to the E&M srvice, but I have concerns in an audit that they will state we added the modifier to push the claim thru their edits for payment. Does anyone have any thoughts on this?
Thanks,
Debbie
 

jccoder

Networker
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43
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We do not use this code, we have been to several conferences and all have agreed that this code should not be used.
 

rthames052006

True Blue
Local Chapter Officer
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1,904
Location
York, Pa
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We do not use this code, we have been to several conferences and all have agreed that this code should not be used.

I just told my doc's the same thing about using that after hours code, it rarely gets reimbursed. We also have an issue with the emergency urgent visit code 99058 ( I believe w/o having my books) We are trying to figure out if there is an alternative to billing that code. One of the docs suggest we bill the pt but I don't think we can do that especially if we are contracted with that particular insurance.

If anyone knows or can suggest some options please email me at:

rthames@heritagemedgrp.com

Thanks,
 
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