tci ED Coding & Reimbursement Alert - 2006 Issue 8

Reader Questions: After-Hours Code Not Always Reimbursed

Question: Is there any way to account for after-hours services that an ED physician provides?Georgia Subscriber Answer: There is an after-hours code on the books, but you-ll likely have a devil of a time getting some payers to recognize it.When your ED physician provides after-hours services, it is possible to report 99053 (Service[s] provided between 10:00 p.m. and 8:00 a.m. at 24-hour facility, in addition to basic service). Caveat: Medicare carriers will not reimburse for 99053. Private payers may accept 99053 -- if it is written into your contract. Reader Questions and You Be the...

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