ED Coding and Reimbursement Alert

Question: At a recent emergency medicine coding conference, I was encouraged to research special services codes 99052 and 99054 for future use on ED claims. I'm an experienced ED coder and have never used these codes, nor am I comfortable using them in addition to 99281-99285 (ED services), 99291 and 99292 (Critical care services). Should I be using these new service codes?

Maryland Subscriber

Answer: Yes, you should look into reporting these special service codes for ED services. Codes 99052 (Services requested between 10:00 PM and 8:00 AM in addition to basic service) and 99054 (Services requested on Sundays and holidays in addition to basic service) can apply to the ED because operating during these hours is frequently more costly. Physicians and nurses often get paid more to work at night and on weekends.

But understand that your question is very controversial, and Medicare does not pay for these codes. Yet other carriers do. One experienced ED coder says that her ED has been reporting 99052 and 99054 for two years, and the commercial payers reimburse them often enough that she finds them worthwhile to use.

So, look into using these codes when appropriate. But before billing them, be sure to check with your payers for their policies if you have contractual obligations.