Oncology & Hematology Coding Alert

Reader Question:

Learn to Live Without 99050 and 99058

Question: We recently began operating an after-hours walk-in clinic for urgent conditions. Would it be correct to charge 99050 (Services requested after office hours in addition to basic service) or 99058 (Office services provided on an emergency basis) in addition to whatever service our oncologist provides during the patient's visit?

Kentucky Subscriber Answer: No. The National Correct Coding Initiative created 99050 and 99058 to compensate a physician for the inconvenience involved in opening for a patient after business hours (99050), or interrupting scheduled appointments to treat a patient (99058).
 
For instance, you may report 99058 if a patient unexpectedly came to your practice complaining of chest pains (786.5x), shortness of breath (786.05), and left arm pain (729.5), and demanded immediate attention. CMS, however, will not reimburse you for 99058 if your practice operates after hours or keeps urgent-care spots open.
 
Furthermore, you keep your office open regardless of the patient's emergency, or if a patient requests an after-hours service. Even so, don't worry about any lost revenue: Medicare and most other carriers do not reimburse these codes. They consider these "bundled" services, and you should not report them separately.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Oncology & Hematology Coding Alert

View All