CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2004 Jan;11(1):22.
Emergency office services
Can you explain the proper use of CPT code 99058, “Office services provided on an emergency basis”? Does it require the physician to be called out of a room in which he or she is seeing another patient?
Code 99058 involves the physician interrupting his or her care of another patient to deal with an emergency. The winter 1994 CPT Assistant states that “if a patient presents at the physician’s office and requires unscheduled emergency care, code 99058 is reported in addition to the other services provided. This is reported for those office patients whose condition, in the clinical judgment of the physician, warrants the physicians interrupting his/her care of another patient to deal with the ‘emergency.’ This code is not reported when the doctor’s practice is to have urgent care slots available in the schedule and patients are ‘fit in’ to the schedule.”
However, neither CPT nor CPT Assistant states that this interruption necessarily extends to being called out of the room in which the physician is currently caring for another patient. For example, a physician could “deal with” an office emergency by providing initial instructions to the clinical staff member who interrupts the physician’s care of another patient to advise him or her of the emergency. The physician could then treat the emergent patient after completing his or her care of the current patient. In this case, the intent of code 99058 would be met, even though the interruption of the physician’s care of another patient did not include leaving the exam room before the encounter was complete.
Note that since CPT considers 99058 to be an “adjunct to the basic services rendered,” it should not be submitted alone; rather, it should be submitted in addition to the other service(s) you rendered to the patient. And Medicare and many other payers consider 99058 bundled with the other service(s) you provided to that patient on that date, so they will not separately reimburse for 99058.
Coding multiple same-day, same-diagnosis visits
What code(s) should I submit for multiple visits on the same day with the same patient for the same diagnosis (e.g., if a hospitalized patient is seen three times during the course of a day as medically indicated)?
If you provide subsequent hospital care in the course of three visits to a patient on the same date, you should only submit the appropriate subsequent hospital care code (99231-99233) once. All of the hospital care codes include the phrase “per day,” which means that each code covers all hospital care provided to that patient on that day by that physician. The level of service in this case should reflect the cumulative history, exam and medical decision making documented during the course of the three visits. Consider reporting a prolonged services code (99356-99357) if the total face-to-face time you spend with the patient exceeds the typical time associated with the appropriate hospital care code by 30 minutes or more.
Excision vs. destruction
What is the correct code for excision of a 1.5-cm premalignant tumor of the left ear with local anesthesia and hemostasis – 17000 or 11442?
A code in the series 11440-11446, which covers “excision” of a benign or premalignant skin lesion of the ear and simple (nonlayered) closure, is probably the most appropriate. You should choose the specific code based on the excised diameter (i.e., lesion plus margin) not just the size of the lesion. For an excision that requires more than simple closure, you should separately report the appropriate intermediate or complex closure codes (12051-12057 or 13150-13153). Code 17000 would not be appropriate since it is for “destruction” rather than “excision” of a benign or premalignant skin lesion.
Editor’s note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the “Documentation Guidelines for Evaluation & Management Services” for the most detailed and up-to-date information.
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Send questions and comments to firstname.lastname@example.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
Copyright © 2004 by the American Academy of Family Physicians.
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