Journal of Urgent Care Medicine

An Urgent Care Approach to Complications and Conditions of Pregnancy

Urgent message: From pregnancy confirmation to the evaluation of bleeding, urgent care centers are often the initial location for management of obstetric issues. Careful use of evidence-based guidelines is the key to successful outcomes. DAVID N. JACKSON, MD, FACOG Introduction Although close to 160 million visits are made to urgent care providers each year in the United States, there are currently no prospective studies describing how pregnancy may initiate or complicate an urgent care consultation. …

An Age-Based Approach to Fever of Uncertain Origin in the Pediatric Patient

Urgent message: Fever in pediatric patients, while frequent, is rarely the result of a serious illness. Urgent care practitioners must be able to consistently distinguish between serious and benign causes with a minimum of invasive testing. BRENDAN KILBANE, MD, FAAP Introduction Ever is one of the most common chief complaints in pediatric patients who present for urgent evaluation. A surprising number of families continue to suffer from “fever phobia,” with one study noting that 91% …

Abstracts in Urgent Care: April, 2013

Soft cast versus rigid cast for treatment of distal radius buckle fractures in children Key point: Buckle fractures of the distal radius can be safely and effectively treated with a soft cast and only a single orthopedic outpatient clinic appointment. Citation: Witney-Lagen C, Smith C, Walsh G. Soft cast versus rigid cast for treatment of distal radius buckle fractures in children. Injury. 2012 Dec 21. pii: S0020-1383(12)00516-5. doi: 10.1016/j.injury.2012.11.018 Buckle fractures are extremely common and …

Abstracts in Urgent Care: February, 2013

Flu Activity Picks Up Nationwide Key point: CDC recommends vaccination and antiviral treat- ment against influenza Citation: http://www.cdc.gov/flu/spotlights/flu-activity-picks- up.htm. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Influenza activity was continuing to increase in the United States and most of the country was experiencing high levels of in- fluenza-like-illness (ILI), according to CDC’s January 4 FluView report. “Reports of influenza-like-illness (ILI) are nearing what have been peak levels during …

An Old Condition Presents New Challenges

Urgent message: Acute rheumatic fever is not common but it does still occur, underscoring the need for head-to-toe examination in patients with vague symptoms that seem unconnected. HEATHER VARLEY, PA-C, and WILLIAM GLUCKMAN, DO, MBA, FACEP Introduction Patients with fever, sore throat, and malaise often present in the urgent care setting and they typically are worked up quickly with a rapid strep test or given a diagnosis of a viral syndrome. The case described here …

Abstracts in Urgent Care: June, 2012

Is Oral Antibiotic Therapy Enough for Children with Acute Pyelonephritis? Key point: A randomized trial failed to prove the acceptability of oral antibiotic monotherapy relative to sequential intravenous and oral therapy, but evidence supporting and treatment alone as an option is accumulating. Citation: Bocquet N, Sergent AA, Jais JP, et al. Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics. 2012; 129(2): e269-275. Children with acute pyelonephritis typically receive intravenous …

Abstracts in Urgent Care: April, 2012

Normalization of Vital Signs Does Not Reduce Risk for Acute Pulmonary Embolism Key point: Up to one-third of patients whose abnormal triage vital signs reverted to normal values had PE. Citation: Kline JA, Corredor DM, Hogg MM, et al. Normalization of vital signs does not reduce the probability of acute pulmonary embolism in symptomatic emergency department patients. Acad Emerg Med. 2010; 19(1): 11-17. In a prospective single-center study, researchers evaluated whether normalization of vital signs …

Abstracts in Urgent Care: March, 2012

Symptoms May Say Sinusitis, But Scans Disagree Key point: Infection and even inflammation were not reliably present in the scans of patients with classic sinusitis symptoms. Citation: Ferguson BJ, Narita M, Yu VL, et al. Prospective observational study of chronic rhinosinusitis: Environment triggers and antibiotic implications. Clin Infect Dis. 2010; 54(1): 62-68. (http://dx.doi.org/10.1093/cid/cir747) Chronic sinusitis can be difficult to diagnose precisely and sometimes even more difficult to treat. Increasingly, experts are suggesting that antibiotics may …

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 …

An Urgent Care Lab as a Profit Center?

Urgent message: An onsite lab can generate significant revenue for your practice. Lab expert Tim Dumas shows how. TIM DUMAS, MLT,CLS Introduction I have been a lab tech for almost 35 years and serve as advisor to 45 physician office labs around the country. I have seen many changes in that time, most for the better. Thirty—even 20—years ago, a stat CBC with differential was a 15-minute-procedure and required a skilled lab tech to get …