CPT code 99058

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165
Location
Dickson, TN
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Physician sees patient that is emergent and disrupts office schedule. Does anyone bill this code with success. We have non coding personnel who were sent to a coding seminar and were told that they can bill for this. We have not seen any documentation that supports this code as yet. and have not billed for this but we are wondering if anyone has examples of documentation requirements and success payment of this code.
thanks in advance
Debbie Potts
 
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626
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0
Physician sees patient that is emergent and disrupts office schedule. Does anyone bill this code with success. We have non coding personnel who were sent to a coding seminar and were told that they can bill for this. We have not seen any documentation that supports this code as yet. and have not billed for this but we are wondering if anyone has examples of documentation requirements and success payment of this code.
thanks in advance
Debbie Potts
CPT 99058 is not a recognized service that is billable to Medicare. The E&M codes will have to be billed according to the actual level of care that is provided to the patient. There is no additional reimbursement by Medicare for disruption of other scheduled services or after hour services in your office and as far as I know this still holds true, but would like to hear also if others have good luck using this code.
 

ollielooya

True Blue
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897
Location
Everett, WA
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0
Sure, you can bill for this code, but it doesn't mean that it will get paid. UNITED plainly states in their policy that they NOT WILL pay for it. MCR will not, so that rules out insurance companies that follow MCR guidelines. I can dig up their policies. Just for a test, we decided about 6 months ago to try billing out for this code, because our doctor provides similiar services. The code is in the book, so why not try? I asked for input ahead of time and received similar advice as to what you've been given, but thought I'd try it anyway. So far, not one insurance company has paid...they're all bundling as we were warned that they would. One of the major carries has a policy where they allow it and I'm in the process of appealing their denial right now with proof in hand. They still denied, so to second appeal status it will go. Ultimately, we're trying every carrier from large to smal (over 30 currently) l and seeing if we get any positive results. If not, will discard submitting it. Frankly, compared to the bills the payers would be getting if the patients presented themselves to the ER instead of utilizing the office facilities, it only makes sense for them to pay for 99058. Maybe that will be a trend of the future? If not, it should be!!! Suzanne E. Byrum, CPC
 
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6
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0
payment for 99058

this code reimburses as an after hour call to avoid the E/R it reimburses at $35 even for some of the payers in the bay area. The icd-9 and soon to be icd-10 should support the after hours/er avoidance criteria.

Generally it is not reimbursable but have seen IPA's paying this as more IPA's take on more financial risk they prefer to avoid hospital costs vs professional in office fee's
 
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