Journal of Urgent Care Medicine

Supervising Physician, Physician Rotation, Critical Care

DAVID STERN, MD (Practice Velocity) Q. Can a Physician Assistant (PA) bill a claim under a supervising physician even when the supervising physician is not physically present during the patient visit? A.A PA can render services when the physician is not on site. Incident-to billing (a specific CMS method for billing midlevel services with the physician as rendering provider) would never apply in this case. Services rendered in this situation should be billed with the …

Preventive Medicine, Preventive Medicine Counseling

DAVID STERN, MD (Practice Velocity) Q. How do you code for a Sexually Transmitted Diseases (STD) screening visit in a patient who has no symptoms? Can you use a preventive medicine code (99387-99397) and still receive reimbursement? A.You would code based on the service provided. If you performed a physical and collected the specimen to send to the lab, then you would bill the appropriate preventive medicine Evaluation and Management (E/M) code. If the only …

2013 Physical Therapy G Codes

DAVID STERN, MD (Practice Velocity) Q. We offer Physical Therapy services to patients in our urgent care center and some patients have Medicare insurance. I understand there are new codes that we must use for Medicare. What are they and how do we use them? A.The Centers for Medicare and Medicaid Services (CMS) was mandated by the Middle Class Tax Relief Act of 2012 to collect information regarding beneficiaries’ function and condition, therapy services furnished, …

Foreign Body Removal, Hydration, and Minor Surgical Procedures with E/M

DAVID STERN, MD (Practice Velocity) Q. We removed an earring that was imbedded in the pinna using general anesthesia? Can we bill CPT code 69205? A.No. CPT code 69205, “Removal foreign body from external auditory canal; with general anesthesia,” is limited to the external auditory canal. The pinna, which also may be referred to as the auricle, is not considered a part of the auditory canal. If an incision was made to remove the embedded …

Mid-level Providers, Resident Providers, Non-payment for S9088, Non-payment for E/M 99205, POS -20 for Family Practice

DAVID STERN, MD (Practice Velocity) Q. Our urgent care is staffed by nurse practitioners (NP) 6 days per week and all of the billing is processed under the medical director for all insurance companies. I have three separate questions: Is it legal for a new Medicare patient entering the ur- gent care setting to be billed under the medical direc- tor if he is not on site and has never seen the patient? Is it …

Primary Care in the Urgent Care Setting, E/M Codes With Other Services, Penicillin Injection

DAVID STERN, MD (Practice Velocity) Q. Can physicians see regular patients and schedule routine care at urgent care facilities? If so, can the urgent care center bill for those services at a separate, lower rate than the urgent care rate? A.Special attention should be paid to payor contracts in these situations. If the insurance company views your patient’s visits as urgent care even though you provided primary care, the patient could be responsible for higher …

Modifier -25 and Urgent Care Codes

DAVID STERN, MD (Practice Velocity) Q. Can a patient be billed for an E/M code and an ultrasound procedure such as 93970, “Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study” during the same visit when both the scan and the E/M visit were performed by the same provider? A. If during an office visit it is determined that the ultrasound procedure needs to be performed on the same …

S9083, Radiology, and E/M Codes

DAVID STERN, MD (Practice Velocity) Q.Can CPT code S9083 be billed with an E/M service code or would this be considered double dipping? You would not typically add CPT code S9083 to an E/M service unless instructed to do so specifically by an insurance company. CPT code S9083, “Global fee urgent care centers,” would be used in instances where the insurance company has stated that the reimbursement is based on a flat rate (global fee …

Inhalation Treatments, OSHA Required Respiratory Questionnaires, Preventive Care Services

DAVID STERN, MD (Practice Velocity) Q.Can nebulizer treatments and instructions for use of the nebulizer inhaler be billed together? Who can perform these services in an urgent care center? A. There are two codes associated with nebulizer treatment and instruction: 94640, “Pressurized or non-pressurized inhalation treat- ment for acute airway obstruction or for sputum induc- tion for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermit- tent positive pressure breathing [IPPB] device”; …

Billing for Medications, Supplies, and X-rays

DAVID STERN, MD (Practice Velocity) Q. What is the CPT code for Tetracaine Ophthalmic used in an urgent care setting? A. If you are referring to the drops used as part of the treatment in the office, then you should not charge separately for them. They are part of the E/M service. If you are providing a bottle of the solution for a patient to use at home, there are a few practical issues to …