The Controversy about 99058

In the latest revision for 2006, CPT has revised one code (99050) for after hours services performed by physicians and hospitals and added several more codes to designate specific times and places of services rendered.

There is one code in the new listing, that is already causing some controversy as to when it is the proper time to use. It is 99058 and it is Schedule Disruption” due to an emergency situation. By the very nature of health care, there are many emergency situations and the code caused confusion from its debut.

The AMA has amended the definition to mean that an emergency is defined by any event that disrupts other scheduled office services”, which is still leaving a great deal about this code up for debate. Be careful if you use this code on your medical billing claims. Without proper documentation to show the disruption and necessity of physician presence, your medical billing claim may only be partially paid or rejected. The revision on the text has helped quell some early confusion. The code now states if the “The pediatrician must stop his normal course of scheduling” to treat the patient in the office, then the services may be coded as 99058. If the physician has to leave his office to treat an emergency situation, use code 99060 to designate emergency services performed out of the office.

One time you do not want to use this code is if you work at an urgent care facility. Because almost every patient that is seen is an emergency situation, there is no need to use the emergency services code.

View all Articles by: Melissa Clark, CCS-P