Internal Medicine Coding Alert

Question: When should we use 99058?

Montana Subscriber

Answer: You should report 99058 (Office services provided on an emergency basis) when your internist interrupts his or her regularly scheduled appointments to treat a patient in an emergency.
 
For example, a patient walks into your internal medicine practice complaining of chest pains (786.50), left arm pain (729.5), and shortness of breath (786.05). Your internist believes the patient may be having a heart attack (410.x, Acute myocardial infarction), so he interrupts the scheduled office appointments to see the patient. Furthermore, your internist can charge for an E/M service, such as 99205 (Office or other outpatient visit for the evaluation and management of a new patient).
 
You cannot report 99058 for after-hours care, and don't use the code if you work in a 24-hour clinic or keep urgent-care slots available during business hours. Many coders shy away from 99058 because some payers will not reimburse for in-office emergency services, although others do. But omitting the code also means you are not accurately reporting a patient visit. And, you'll never know if your insurer will pay for the code until you submit it.
 
To help justify your 99058 usage, encourage your physician to include the specifics of the emergency interruption. The documentation doesn't have to be extensive. For the heart-attack patient, for instance, your internist could write, "Had to treat emergency patient out of turn."