OV and ER code

How should we bill 99058 and an OV code? They keep denying it as bundled service.

99058

CPT® code 99058 is not a recognized service billable to the Medicare program. The services are billed according to the actual level of care provided to the patient. There is no additional reimbursement for disruption of other scheduled office services. bundled means no additional reimbursement.

re: OV and ER code

I attended the Coding & Medicare Update 2012 seminar by Practice Management Institute yesterday and was told that we could bill 99058 for walk-ins. However, I could not find this code listed on the MEDICAID fee schedule nor on the Blue Cross fee schedule. I do not understand why we cannot bill for this when it is listed in the 2012 CPT®. Can someone please clarify? Thanks!

re: OV and ER code

Just because there is a code in CPT® does not mean you will be reimbursed. The payors decide what is covered or not.

re: OV and ER code

CPT® develops the codes, and Medicare (through their fee schedule) assigns a status indicator to the code. It starts with
A--active
B--bundled
etc

Some have N non covered as a status indicator

A service that is bundled may not be billed to a Medicare patient under any circumstances. Services that are non-covered may be billed. Other payers may or may not follow Medicare's decisions about the status of codes.

This might help:
http://codapedia.com/article_334_Medicare-Physician-Fee-Schedule-Data-Base.cfm

re: OV and ER code

You can bill 99058 with an office visit, but it's up to each insurance's discretion as to whether they will pay it. The doctor I bill for used this procedure a lot for a couple of years. Only Cigna and a couple of others will pay it. Most of the time, it's a forced write off. The problem came in when the insurances that do cover it applied it to the deductible or charged a co-insurance. That produced a lot of angry patient phone calls. It made people really angry that the doctor would charge extra to be seen the same day because they were sick and needed to be seen right away. It was more trouble than it was worth.

re: OV and ER code

I must reply to this. The patients are free to be angry, but be angry at their insurer or employer, not the doctor. The code was established because there is extra value to being seen the same day; there is increased risk and work for the doctor and the insurer recognizes this and agrees that the service can be charged and should be paid. If they do not like it, they can find another doctor. You get what you pay for...

re: OV and ER code (99058)

I'm another one who must comment as to the use of 99058. We've been using it with minimal success. Most of the larger insurance companies will not pay, but some of the smaller ones will. I found a policy from Cigna where it states they will pay for this adjunct service code, but have had no luck in getting them to do so, even when appealing it twice. We haven't given up, but if we do it will be because from a fiscal viewpoint it makes no sense to keep spinning our wheels. Hopefully one day the carriers will embrace it and pay because it really provides great savings when the patient can be seen at the physicians office as opposed to utilizing hospital services.
BTW for those companies who have paid, we have seen from $10.00 - $33.00 in additional reimbursement---Suzanne