Practice Management
“Low blood sugar” was his chief complaint, but Thomas was in my urgent care (UC) mostly because he was feeling anxious. It wasn’t hypoglycemia that was making him nervous either. Thomas didn’t have diabetes or take any medication for high blood sugar. Regardless, he was wearing a continuous glucose monitor (CGM), which he lifted his shirt to show me when I entered the room. Thomas explained his primary care physician (PCP) had prescribed the device …
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Urgent Message: Rural urgent care is the industry’s fastest growing segment, influenced by rural primary care shortages, hospital closures and extended ED wait times, but operational staffing and reimbursement complexities must be navigated. Alan A. Ayers, MBA, MAcc Citation: Ayers A. Rural Urgent Care Grows, But Challenges Remain. J Urgent Care Med. 2024; 19(3): 17-21 As access to care in rural areas continues to decline, urgent care (UC) can play a pivotal role in the …
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Urgent Message: Fractures of the midshaft ulna, commonly referred to as “nightstick fractures,” typically occur after direct injury to a forearm outstretched above the head as a protective mechanism. Evaluation includes inquiry into the circumstances of the assault, assessment for any other areas of trauma, examination of the skin, wrist and elbow joints, and radiography of the forearm. Management of closed, nondisplaced midshaft ulnar fractures centers around splint immobilization and arrangement of appropriate follow-up. Chandrika …
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The percentage of urgent care visits involving a laceration procedure increased slightly from 0.75% in 2023 to 0.76% year-to-date in 2024, which is on-par with 2018 levels, according to Experity EMR analysis of more than 93.8 million urgent care visits, as of October 6, 2024. Over the past 15 years, the percentage of patients presenting with a laceration has gradually declined, attributed to a number of factors—chief among them being “case rate” reimbursement. Case rate …
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A 55-year-old woman presents to urgent care complaining of pain when she moves her right wrist. She reports the pain began suddenly when she woke up that morning without any known trauma. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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A 35-year-old male with a history of end-stage-renal-disease (ESRD) presents to urgent care complaining of back pain. The patient missed his dialysis session today because of the pain. An ECG is obtained. View the ECG captured below and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 15-year-old girl presents to urgent care with complaints of fever, arthralgia, abdominal pain, and a widespread rash that developed over the last 2 days. The patient says that the pain in her knees is severe and debilitating. On examination, the patient has a temperature of 100.3°F (37.9°C) as well as maroon and violaceous, purpuric papules and plaques on the legs, buttocks, and face. Laboratory examination shows elevated erythrocyte sedimentation rate and C-reactive protein, proteinuria, …
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Urgent Message: Abdominal pseudohernia is a rare diagnosis with variable presentation. Urgent care clinicians who are familiar with the condition and its variable presentations can reduce the risk of diagnostic errors and unnecessary or inappropriate diagnostic testing. Berkeley E Prewett, BSA; Stephen V Green, MD; Andrew L Juergens II, MD; Taylor K Ratcliff, MD Citation: Prewett BE, Green SV, Juergens AL, Ratcliff TK. Abdominal Pseudohernia and Urinary Retention Due to Spinal Nerve Root Compression From …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. …
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President-elect Trump has announced his intended appointment of Janette Nesheiwat, MD, to be the next surgeon general, according to NPR. She is currently a medical director for CityMD and has contributed to Fox News. With a specialization in emergency and family medicine, she is known for supporting vaccine efforts with an emphasis on the balance of risk and benefit. CityMD merged with Summit Health and was ultimately acquired by VillageMD in early 2023 for $8.9 …
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