Wiki FP coding urgent codes

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Sadams51

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I work in a family practice/peds setting, hours of operations are 8:30am-5pm Monday -Friday. My employer and I had almost an heated discussion where I was told to use
urgent care visit code when a patient comes in without a scheduled appointment. My concerns with this are, we are not urgent care facitlity, we are PCP and have signs posted "walkins are welcome", as far as I know non of our contracts with payors stipulates they will pay for urgent care codes. I am now under a lot of pressure to code as such but refuse to until I am better educated on this. I asked my employee what constitute as "emergency" I was told that "any unscheduled appointment is an urgent code visit, you can call on the same day and its urgent, you need to be seen right away it is urgent". My question is can urgent care codes be used in a in FP office? Please help. Thanks:confused:
 
As a PCP you can bill emergency codes (however most payers do not cover these).

99051 - Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.

99058 - Services provided on an emergency basis in the office, which disrputs other scheduled office services.
These codes can be found in 2013 CPT Porfessional Edition page 556 and 557.

We have found the 99058 may get covered if it is truly an emergency. If someone came in with a cold that was not covered. However, if someone came in with chest pain this may be covered based on insurance.

Hope this helps out.
 
Thanks, it does help and those are the codes that I was looking at. However, my concerns with this are, my employer wants me to bill for unscheduled appointments, walk-ins (thats what my employer refers to as emergency visit. Also we are mostly medicare/medicad capitated and the few private/ffs payors do not have this in our contract. I am still not quite sure. Thanks again
 
99051, 99058

These codes would be used in addition to normal E&M visit codes 99201-99215. I would just make sure if your provider wants to bill them that there is additional documentation of the "urgency" of the care invloved. Most payors are not going to cover these codes.
 
Thank you and yes everything you mentioned is what I explained to my employer. Thank for the feedback.
 
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