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99058-I am wondering

  1. #1
    Default 99058-I am wondering
    Medical Coding Books
    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.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  2. #2
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    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.

  3. #3
    Location
    Alexandria, VA
    Posts
    390
    Smile
    Quote Originally Posted by rthames052006 View Post
    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

  4. Default 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

  5. #5
    Default
    Quote Originally Posted by YTHASKINS View Post
    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
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  6. #6
    Location
    Colorado Springs, CO
    Posts
    12
    Default 99058
    We bill urgent care claims and bill the 99058 for every claim . Should we be using this code for our claims,?

  7. Default 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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