Questions for Dr. Stern
About Your Urgent Care Center
16. I am new to coding for urgent care. My background is primary care. I have some questions about codes 99051 and 99058. 99051 -- Is there a true definition for evening or should I just use for 5:00 and later? I understand it can be used for Saturday, Sunday and national holidays. If I use this code, do I need a modifier?
Most centers use after 5:00PM (no official definition). No modifier needed. 99058 -- What is considered emergent? Is this based on diagnosis? Is there any special documentation that must de done? Does it require a modifier? 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." No modifier needed.
