“I had a patient call me worried about a possible diabetic foot infection. The patient has a history of below the knee amputation at the other limb and was panicked about the potential loss of limb. I worked them into the schedule that day and I am thinking about coding CPT 99058 in addition to the E/M code. Can I get paid for CPT 99058 and does it matter if the potential “infection” turned out to be not infected?”
So, a patient called the physician’s office, worried about the possibility of a diabetic foot infection. Based upon the fact that the patient unfortunately had a BKA on the opposite extremity, the patient was worked into the schedule that day.
Let’s take a look at CPT code 99058 which is listed in the “Special Services, Procedures and Reports Section” of the CPT Manual under “Miscellaneous Services.”
CPT 99058 is defined as the following: Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to the basic service. CPT 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.”
Well, the patient did not just show up at the office. The patient was scheduled or “worked into the schedule” that day. There was not a disruption of the other scheduled office services, nor was the care of another patient interrupted in order to address the presenting issue. Fortunately the patient did not have a diabetic foot infection. Since the encounter did not meet the criteria of CPT code 99058, this code should not be billed on this date of service. The only code(s) that can be billed would be those that addressed the patient’s presenting problem that day in the office.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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