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 …
Read MoreModifier -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 …
Read MoreS9083, 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 …
Read MoreInhalation 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”; …
Read MoreBilling 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 …
Read MoreFracture 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 …
Read MoreTetanus 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 …
Read MoreE/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 …
Read MoreHospital 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 …
Read MoreBenchmarks 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 …
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