2025 CPT code 99058
(Active) Effective Date: N/A Medicine Services and Procedures > Special Services, Procedures and Reports Feed
Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service
Modifiers may be applicable to the E/M code reported with 99058, but not to 99058 itself. Common modifiers used with E/M codes can include modifiers 25 (Significant Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service), 52 (Reduced Services) or 53 (Discontinued Procedure) if applicable to the situation.
Medical necessity is established by the presence of an acute medical condition that requires immediate attention and cannot wait for a scheduled appointment, thus justifying the disruption to other scheduled services.
The provider is responsible for assessing and treating the patient presenting with an emergent problem during regular office hours, necessitating the disruption of other scheduled appointments.
In simple words: This code covers emergency services provided in a doctor's office during normal hours, without an appointment, and requiring other scheduled patients to be moved or rescheduled. The doctor must document the emergency nature of the visit.
The provider renders emergency services to a patient in the provider’s office during regular office hours without an appointment and ahead of other scheduled patients. Report this code in addition to the appropriate evaluation and management, or E/M, code that describes the services rendered. Two key words to remember when considering 99058 are “emergency” and “interruption”. If the patient arrives unexpectedly, has an emergency need, and other schedules are changed to accommodate the patient, the visit qualifies for 99058. If you had an opening in your schedule and other appointments were not impacted, do not report 99058. Verify that the provider includes adequate documentation in the patient record supporting 99058. Payers want to know that the provider treated the patient for an emergent problem and fit the patient into the schedule because of that problem. A walk-in patient does not automatically qualify for 99058. The patient must have an acute, or sudden and urgent, problem that demands assessment and treatment.
Example 1: A patient with a sudden onset of severe chest pain arrives at the clinic without an appointment during regular business hours. The physician sees the patient immediately, disrupting the scheduled appointments of other patients. The physician performs an EKG and other tests to rule out a heart attack., A child is brought to the office without an appointment during regular hours with a deep laceration that requires immediate suturing. The physician interrupts the current schedule to treat the child., A pregnant patient arrives at the clinic unannounced and reports signs of premature labor.The physician sees her immediately to evaluate the situation, which requires rescheduling several patients who had pre-booked appointments.
The documentation must clearly support the emergency nature of the visit, the reason for interrupting other scheduled services, and the medical services provided.This includes details of the patient's presenting complaint, the findings of the examination and any tests performed, and the treatment provided.
- Revenue Code: M1B - OFFICE VISITS - ESTABLISHED
- Place of Service:Office