Pediatric Coding Alert

Question: We recently hired a new pediatrician who is questioning whether we can bill any extra codes for a walk-in established patient. He told us that his previous pediatric practice was able to collect for the office visit code and 99058. Is this accurate?

South Carolina Subscriber

Answer: Many practices do collect for 99058 (Services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) when billed with office visits, but the answer to your question depends on the patient and the insurer.

In most pediatric practices, the staff members will triage the patient to determine if the condition is considered emergent. If it's determined to be non-emergent, they offer the patient the next available appointment, and if the patient needs to be seen immediately, they will disrupt the physician's schedule to ensure that the walk-in patient is seen.

There are some situations in which you can report the office visit code (99212-99215) with 99058. The severity of the illness or the injury determines the appropriate use of the 99058 code. It is not just a walk-in code, but is required to address a problem that demands the physician's immediate attention, therefore disrupting their schedule.