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after hours code 99053

  1. #1
    Default after hours code 99053
    Medical Coding Books
    I am interested to find out if anyone is billing for this code and if they are being reimbursed. We have a few carriers that have stated they allow for this code, but sometimes the claims are bundled. When we send for an appeal, we add modifier 25 to the E&M srvice, but I have concerns in an audit that they will state we added the modifier to push the claim thru their edits for payment. Does anyone have any thoughts on this?

  2. #2
    Default after hours code 99053
    We do not use this code, we have been to several conferences and all have agreed that this code should not be used.

  3. #3
    Quote Originally Posted by jccoder View Post
    We do not use this code, we have been to several conferences and all have agreed that this code should not be used.
    I just told my doc's the same thing about using that after hours code, it rarely gets reimbursed. We also have an issue with the emergency urgent visit code 99058 ( I believe w/o having my books) We are trying to figure out if there is an alternative to billing that code. One of the docs suggest we bill the pt but I don't think we can do that especially if we are contracted with that particular insurance.

    If anyone knows or can suggest some options please email me at:

    Roxanne Thames CPC, CPC-I, CEMC

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

  4. #4
    Thanks for the replies! Debbie

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