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definition of 99053

  1. Default definition of 99053
    Medical Coding Books
    how would i appropriately use this code 99053? definition in CPT is a little confusing? Can a hospital doc use along with procedures if he is on call?

  2. Default
    I have never used this code. What kind of services did the doctor provide that you believe warrants and adjunct code? I agree, the definition is not very clear.

  3. Default
    we are trying to see if it would warrent hospital consult and/or surgeries?

  4. Default
    I have experience in billing 99053 for providers of emergency department when the services (E/M or any surgical procedure) are provided between 10.00 p.m to 8.00 a.m

  5. Default Cpt 99053

    While searching on this topic, I found your question...I too am being asked about this. I work at a large medical center, and the MD's are constantly called in to do either procedures or consults. Does this warrant a 99053? I only find references to the ED.

    Thank you so much for any help you can give. My e-mail address is:


  6. #6
    Milwaukee WI
    Default We're looking into it.
    We are looking into using this code (general surgeons in a pediatric hospital).

    We believe that it is warranted when the services are provided between 10p and 8a. Our Compliance Dept has looked as several examples we gave and they indicated that the charges might be warranted IF ..the doctors document the time of service. (We chose the samples based on time of admit being midnight-8a when we were fairly positive that the service was provided between 10p and 8a. BUT they weren't documented as such ... more physician training if we go forward. In our admittedly unscientific, small sample population 35% of the patients on service on one day had been admitted in this time frame.)

    Also, government payers will not cover this (Medicare and Medicaid). United Health Care and Anthem also do not cover this.

    Part of our discussion in our practice is do we want to use the code at all, knowing in advance that many carriers will not cover it and that patients may then be responsible for this additional fee.

    Everyone is scrambling for a bigger piece of the market ... do we want to upset our patients by adding this relatively small fee (thereby encouraging them to seek care elsewhere)?

    We haven't made a decision yet ... like I said, we're looking into it.

    F Tessa Bartels, CPC, CEMC

  7. #7
    Default 99053
    we just started using 99053 for our ER docs. We are also going by the arrival time.........

  8. #8
    What if no procedures were done? Never even touched the patient??? Pt transferred from one facility to another only because the lab at the original facility was closed. No dx even.

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