Eliminate Confusion Over 99053 and 99058 in Billing

There were two new codes issued in 2006 that continue to confuse many medical billers. These two codes were created to specifically address the after-hours and red-eye services for procedures done by physicians outside the normal hours.

Previously when compiling the medical coding for medical billing, a coder would have used 99050 as a “catch-all” coding. Now CPT has revised the original code and added new codes. 99053 is “for services between 10 p.m. and 8 a.m. in 24-hour facilities,” and will be used by both physicians on call and hospitals.

Please note that code 99053’s wording to include “24-hour facility” will put a new limitation on using late night service codes. Previously a coder would have simply used 99052 to designate a meeting between a physician and a patient after 10PM but before 8AM.

The new coding language will mean the proper way to report this incident will be to determining the POS (Place of Service) and use the proper new code. In order to use 99053, the service must occur at a 24-hour facility, such as an ambulatory surgical center (POS 24), urgent care facility (POS 20), or emergency room (POS 23).

CPT has made it easier and more exacting to do your coding so carriers can better determine the eligibility of the medical billing claims. Previously, many 99050 claims were submitted without proper modifiers or with enough documentation to ascertain the time or POS. The updated coding system will make it easier to pinpoint the time and place of services,

There may be some tighter clarifications coming for this code group in 2007, until then – make sure you use the correct CPT code and back it up with good documentation and your reimbursements should be unaffected.

View all Articles by: Kathryn E, CCS-P - Retired