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Thread: Billing for 99053

  1. #1
    Join Date
    Apr 2007

    Default Billing for 99053

    AAPC: Back to School
    I have a doctor who wants to bill out 99053 in conjunction with a procedure code and IP hospital consult. If she was on call, can she bill out the 99053?

  2. #2



    From what I know of the 99053 code it is a billable code for physicians who meet the criteria and it can be used as add on code to the consult code. However, depending on the procedure code you may be turning your wheels if there is a global. Just remember you can code it but most carriers do not pay for it. Call your carriers to see who does pay for the code for you are not loosing out on reimbursement.

    Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default We tried this

    We tried using this for our practice when service was provided between midnight and 6 am - only for patients coming through the ER ... we wanted to keep the sample population manageable. After six months of using the code we found we were paid -- twice.

    All others were denied as "global" - so not billable to the patient.

    We decided it's not worth the time and effort to bill and track this service, so we stopped using it.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007


    I used to work for a company that billed for ED and they billed 99053 for commercial carriers (other than anthem) with modifier 25 on the E & M code and I can only assume that we were being paid because they continued to bill it for years and years. So I agree with what the other person said, check with your local carriers and see who pays it. Also, maybe try appending modifier 25 to the E & M service.

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