How To Use CPT Code 99053

CPT 99053 refers to services provided between 10:00 PM and 8:00 AM at a 24-hour facility, in addition to basic service. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99053 procedures.

1. What is CPT 99053?

CPT 99053 is a code used to bill for services provided by healthcare professionals at a 24-hour facility during nighttime hours, specifically between 10:00 PM and 8:00 AM. This code is billed in addition to the basic service provided, such as evaluation and management (E/M) services.

2. 99053 CPT code description

The official description of CPT code 99053 is: “Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service.”

3. Procedure

The 99053 procedure involves the following steps:

1. The healthcare provider arrives at the 24-hour facility during the specified nighttime hours (10:00 PM to 8:00 AM).
2. The provider evaluates the patient and determines the appropriate course of action.
3. The provider administers the necessary treatment or intervention.
4. Documentation of the services provided is completed, including the time of service.
5. The provider bills for the basic service (e.g., E/M service) and adds CPT 99053 to the claim to account for the nighttime hours.

4. Qualifying circumstances

Eligibility for CPT code 99053 services is determined by the following criteria:

• The service must be provided at a 24-hour facility, such as an urgent care center or emergency department.
• The service must be rendered between the hours of 10:00 PM and 8:00 AM.
• The provider must be treating a patient during the specified nighttime hours.
• The basic service (e.g., E/M service) must be billed in addition to CPT 99053.

5. When to use CPT code 99053

It is appropriate to bill the 99053 CPT code when a healthcare provider renders services at a 24-hour facility during the specified nighttime hours (10:00 PM to 8:00 AM) and the basic service (e.g., E/M service) is also billed. The code should not be used if the service is provided outside of the specified hours or if the facility is not a 24-hour facility.

6. Documentation requirements

To support a claim for CPT 99053, the following information must be documented:

• The date and time of service, confirming that the service was provided between 10:00 PM and 8:00 AM.
• The type of 24-hour facility where the service was rendered (e.g., urgent care center, emergency department).
• A detailed description of the services provided, including the basic service (e.g., E/M service) and any additional interventions or treatments.
• Any relevant patient information, such as medical history, symptoms, and diagnosis.

7. Billing guidelines

When billing for CPT code 99053, keep in mind the following guidelines:

• Ensure that the service was provided at a 24-hour facility during the specified nighttime hours (10:00 PM to 8:00 AM).
• Bill the basic service (e.g., E/M service) in addition to CPT 99053.
• Document all necessary information to support the claim, as outlined in the documentation requirements section.
• Review any payer-specific guidelines or policies related to billing for CPT 99053.

8. Historical information

CPT 99053 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Similar codes to CPT 99053

Five similar codes to CPT 99053 and how they differ are as follows:

1. CPT 99050: This code is used for services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
2. CPT 99051: This code is used for services provided during regularly scheduled evening, weekend, or holiday office hours.
3. CPT 99058: This code is used for services provided on an emergency basis in the office, disrupting other scheduled office services.
4. CPT 99060: This code is used for services provided on an emergency basis outside of the office.
5. CPT 99056: This code is used for services provided on an unscheduled basis, typically when the patient is seen outside of normal business hours.

10. Examples

Here are 10 detailed examples of CPT code 99053 procedures:

1. A patient arrives at an urgent care center at 11:30 PM with severe abdominal pain. The provider evaluates the patient, administers pain medication, and orders diagnostic tests. CPT 99053 is billed in addition to the E/M service.
2. A patient visits the emergency department at 2:00 AM with chest pain. The provider performs an E/M service, orders an EKG, and administers medication. CPT 99053 is billed in addition to the E/M service.
3. A patient is seen at an urgent care center at 4:30 AM for a severe asthma attack. The provider administers a nebulizer treatment and monitors the patient’s condition. CPT 99053 is billed in addition to the E/M service.
4. A patient arrives at the emergency department at 1:00 AM with a high fever and severe headache. The provider performs a lumbar puncture to rule out meningitis. CPT 99053 is billed in addition to the E/M service.
5. A patient visits an urgent care center at 5:00 AM with a severe allergic reaction. The provider administers an epinephrine injection and monitors the patient’s condition. CPT 99053 is billed in addition to the E/M service.
6. A patient is seen at the emergency department at 3:30 AM for a suspected broken arm. The provider orders an X-ray, applies a splint, and prescribes pain medication. CPT 99053 is billed in addition to the E/M service.
7. A patient arrives at an urgent care center at 11:00 PM with a severe laceration. The provider cleans the wound, sutures the laceration, and administers a tetanus shot. CPT 99053 is billed in addition to the E/M service.
8. A patient visits the emergency department at 6:00 AM with severe shortness of breath. The provider orders a chest X-ray, administers oxygen, and prescribes medication. CPT 99053 is billed in addition to the E/M service.
9. A patient is seen at an urgent care center at 12:30 AM for a severe migraine. The provider administers a medication to alleviate the migraine and monitors the patient’s condition. CPT 99053 is billed in addition to the E/M service.
10. A patient arrives at the emergency department at 7:30 AM with a suspected stroke. The provider performs a neurological examination, orders a CT scan, and administers medication. CPT 99053 is billed in addition to the E/M service.