03/11/2022

Billing for Emergency Visit, CPT 11730 and X-Ray

Had patient coming in on a Sunday and want to bill CPT code 99058 for an Emergency visit along with procedure code 11730 and x-ray but can't use modifier with CPT 99058. Afraid that if I send two claims for same date of service I won't get paid. How am I to bill?

If services were provided in the office in an emergency basis, CPT 99058 should not be reported with a modifier. The nail avulsion & x-ray should be coded as if the patient was not seen in emergent circumstances. CPT 99058 does not require a modifier to be paid- it should be reported on the claim with no modifiers. Most insurances do not cover this add-on code- even if services are provided after regularly scheduled hours or on an emergent basis. CPT 99058 is likely to be bundled with the payment for the nail avulsion since most insurances do not reimburse the add-on code separately.