Emergency after hours care

chyatt

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St. Louis
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One of the physician's in our RHC encountered an issue I've never run into. Last evening a patient of this physician's brought her daughter to the physicians home with a chief complaint of a finger contusion from a softball game. This physican went with the family to the radiology dept at our hospital. He ordered the x-ray and made a diagnosis of a fracture. He then splinted the finger in a small room in the adjoining room (which is our ER). This pt was not seen by an ER physician or anyone else in the ER. Dr. wants to bill: 99214; 99056; 99058 and 99050. I'm thinking 99214 & 99056. Does anyone else have any thoughts?
 

Lorisvg

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It sounds like he doesn't want the patient to pull that trick again!
99050 and 99058 apply to services in the office.
99056 describes the situation, I would use that
As for 99214, if the pt wasn't registered in the ER, then this is the right code area to look at. I would double check his documentation to make sure he has a solid 99214, as I suspect that 99056 will cause extra scrutiny from the payer.
 
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4,466
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Milwaukee WI
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What about fracture care

Aren't you also going to bill for the fracture care - or at least application of finger splint? (don't forget the modifier on your E&M if you bill for the care)
F Tessa Bartels
 

rthames052006

True Blue
Local Chapter Officer
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York, Pa
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I work for a Family Practice that sees pt's and uses the 99058 along with a e/m level say 99214, I am not really familiar with these codes 99058 as the office I previously worked for never used them. My question is what type of documentation would be sufficient to support using the 99058.

Any reference materials I could look thru/ or suggestions/comments would be greatly appreciated.

TIA
 

halebill

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Capital Coders, Columbia, SC
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Certainly, your physician must have received reimbursement for this by now. What did he end up billing? I'm thinking, treat finger fracture, professional component of the Xray (since he used the hospital's equipment) and maybe the 99058?

Bill Hale, CPC
 
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