Primary Care Coding Alert

Question: Our family practice sees patients by appointment only. Occasionally, we have an acutely ill or injured patient who walks in unscheduled. Is there an urgent care code that we can use to bill these charges?

Illinois Subscriber
  
Answer: Yes, 99058 (Office services provided on an emergency basis) exists for unscheduled in-office non-Medicare patient emergency care. This code describes treating a patient whose condition, in your FP's clinical judgment, warrants interrupting his care of another patient to deal with the "emergency," CPT states. Because 99058 is an adjunct code, you should report it in addition to the other FP-provided services, such as an established patient office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).
 
For instance, a 1-year-old boy just learning to stand pulls a dining-room chair on top of himself, causing a small laceration on the forehead. Your FP interrupts his schedule to suture the 1.5-cm wound and also checks the child for other signs of head trauma, performing a thorough neurological examination. In this case, you should report 99058 in addition to the other FP-provided services, 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) and 99212-99215-25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
Make sure that you report 99058 to private insurers only. If a third-party payer doesn't cover the urgent care code, add 99058 to your contract as a noncovered service. That way, if the situation arises, you can collect the charge from the patient.
 
Be careful not to bill Medicare patients for this code. Medicare designates 99058 as a bundled service and includes payment for the emergency office care in the same-day charges. - Answers to You Be the Coder and Reader Questions provided by Jaime Darling, CPC, certified coder for Graybill Medical Group, which has nine family physicians, in Escondido, Calif.; Daniel S. Fick, MD, assistant dean for clinical affairs at Carver College of Medicine and senior assistant hospital director at University of Iowa Hospitals and Clinics in Iowa City; and Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.