Journal of Urgent Care Medicine

Fracture Care, Laceration Kits, Reimbursement for Extended Hours

DAVID STERN, MD (Practice Velocity) Q. When is it appropriate to use fracture codes without manipulation? If a patient comes in with pain in a finger after a fall and an E/M is performed, x-rays are taken to confirm a fracture, the finger is splinted and the patient is referred to an orthopedist, would that treatment constitute billing for initial care? If not, what must we do to be able to bill these? A. CPT …

Tetanus Code Change, Coding Injections and Infusions, Facility and After Hours Codes

DAVID STERN, MD (Practice Velocity) Q. What codes should we use in place of the discontinued 90701 (tetanus vaccines, diphtheria, tetanus toxoids, and whole cell pertussis vaccine [DTP], for intramuscular use) and 90718 (tetanus and diphtheria toxoids [Td] absorbed when administered to individuals 7 years or older, for intramuscular use) that were discontinued effective July 1, 2012? A. You should use 90714 (Tetanus and diphtheria toxoids [Td] absorbed, preservative free, for use in individuals 7 …

E/M Coding for Multiple Visits, Contracted Case-rate Billing, Comparing Payor Reimbursement Policies

DAVID STERN, MD (Practice Velocity) Q. We sometimes have patients who require two visits to clear impacted cerumen in their ears. In some cases, this procedure requires a 24-hour regimen to soften the cerumen prior to flushing the ear. How do we bill for the second visit and does it change how we bill if we find a second diagnosis after we clear the cerumen? A. For the second visit, you may code for all …

Hospital Emergency Departments and Urgent Care Proximity, New vs. Established Patients using E/M Coding, Private Practice Urgent Care Coding

DAVID STERN, MD (Practice Velocity) Q. If a practice buys or opens an urgent care facility that is not in a hospital nor affiliated with a hospital, should we be using routine E/M codes for our visits? Secondly, do we have to follow the Emergency Medical Treatment and Active Labor Act (EMTALA) Guidelines? A. Yes. You should use the same E/M codes as used by the physician offices (990201-99215). EMTALA does not apply to urgent …

Benchmarks for E/M Codes; Place of Service (POS) Codes

DAVID STERN, MD (Practice Velocity) Q. Is there a benchmark for E/M codes in the urgent care setting? For instance, are there a certain percentage of 99213 vs. 99214 for established patients? Currently out urgent care providers’ coding is being compared to CMS Family Practice standard. A. To my knowledge, there is no published information detailing E/M distribution for urgent care facilities. If there was, however, it would simply document what was actually being coded …

Coding of Multiple Wound Repairs, Coding an E/M, IV Infusion, Coding of the Comprehensive Metabolic Panel

DAVID STERN, MD (Practice Velocity) Q. We have a patient with several lacerations to both of his hands. On his left hand, we sutured a total of three lacerations that have a grand total of 3.5 cm and on his right hand, we sutured on laceration with a total of 3.0 cm. What is the best way to code this? A. Assuming that all the procedures were simple wound repairs, you would simply add the …

Medicare Modifier PD, Fracture Visit Coding, Coding for Emergent Transport, ‘Big Ticket’ Reimbursement Codes, Medicare CLIA-Waived Codes

DAVID STERN, MD (Practice Velocity) Q. What is the new modifier PD? A. If your urgent care center is owned by a hospital or health system, then Medicare has a new modifier for your center. The new HCPCS Level II Modifier PD is defined as a “diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or …

Coding for I&D Follow-Up, R-codes and POS 20, Coding for Compression Bandage

DAVID STERN, MD (Practice Velocity) Q.We have so many MRSA (methicillin-resistant Staphylococcus aureus) I&Ds (incision and drainage). The follow-up for changing the packing are numerous and time-consuming, and it feels wrong to have them just included in the global procedure like any other wound check or suture removal. What’s the right way to handle this? Annie Miranda, Hopewell Junction, NY A. This is a complicated question. To code these procedures, you can consider using the …

Administration Codes for Injections, Billing for Medicare Wellness Exam, Billing Joint Injections With E/Ms, Coding for Keloid Injection

DAVID STERN, MD (Practice Velocity) Q. What is the appropriate administration code for a Medicare patient who receives influenza, Pneumovax, and tetanus vaccinations? What are the proper administration codes for the same patient if he/she receives a tetanus and flu shot? Name Withheld A. For Medicare: Influenza vaccine administration is G0008 Pneumovax administration is G0009 Tetanus vaccine administration is 90471 Q. If you perform an annual Medicare wellness exam, can you bill for additional services …

Modifier for 69210, HCPCS for IM Zofran, S9088 vs 99051, and Billed Amount for 99051

Q.What modifier can I use for CPT Code 69210 (removal impacted cerumen, [separate procedure], one or both ears) for Medicare? I used left and right, but the claim was denied as an incorrect modifier. A.Because the definition of the code includes either or both ear(s), you should not attach a modifier to indicate the right (-R), left (-L), or bilateral (50) ear(s). Q.My physicians like to give Zofran injectable intramuscular; we generally don’t give it …