Practice Management Alert

Question: When is it appropriate to bill 99058? We recently began operating an after-hours walk-in clinic for urgent conditions. Can we use 99058 or 99050 in addition to whatever services the physician provides at this clinic?

Florida Subscriber

Answer: You should report 99058 (Office services provided on an emergency basis) when your physician interrupts his regularly scheduled appointments to treat a patient in an emergency. For example, if a patient walks in complaining of chest pains and left arm pain, your physician may believe the patient is having a heart attack. If the physician interrupts the scheduled office appointments to see the patient, you can report 99058 and bill 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. Also, don't use the code if you work in a 24-hour clinic or keep urgent-care slots available during business hours. The National Correct Coding Initiative created 99058 and 99050 (Services requested after posted office hours in addition to basic service) to compensate a physician for the inconvenience involved in opening for a patient after business hours. Also, the codes represent the time and expense of keeping an office open past regular office hours, either for the patient's convenience (99050) or because the patient had an emergency (99058). If your practice elects to have extended hours to accommodate walk-ins or urgent care, neither of these codes would apply.

It's worth a try: Some billers shy away from using 99058 because Medicare does not reimburse it and many third-party payers follow suit. However, some carriers will pay for the code, and you'll never know unless you submit the claim. Furthermore, omitting the code means you are not accurately reporting the patient's visit.

To help justify reporting 99058, encourage your physician to include the specifics of the emergency interruption. The documentation doesn't have to be extensive, and could be as simple as a note that says, "Had to treat emergency patient out of turn."