DAVID STERN, MD (Practice Velocity) Q. We have quite a few primary care physicians who regularly send patients to our urgent care center for x-rays. These patients have a prescription for the x-ray service, and they don’t want to be seen by the urgent care doctor. I have several questions related to this service: Should we collect the urgent care copay (or) radiology imaging services copay (which is usually $0)? Should we code S9083 to …
Read MoreConsult Codes, Injection Codes, and Coding for Diabetes Education and In-House Dispensing
Q. My codes for consults seem to suddenly be getting denied as invalid. I checked my CPT book, and the codes are still listed as valid. What’s going on? Question submitted by multiple urgent care billers A. Yes, you are right that the consultation codes (99241-99245, 99251-99255) are still valid per CPT, as published by the AMA. CMS, however, has decided to no longer reimburse for those codes and has now changed the status indicator …
Read MoreCoding for Two Visits in One Day, Billing for Atypical Urgent Care Services, and Billing on the UB-04
Q. The patient in question is a new patient to the urgent care. At 10 a.m., she visited the urgent care with chief complaint of cough, headache, and myalgias. She was discharged home with a final diagnosis of cough and prescription for ibuprofen and cough syrup. At 3 p.m., she retuned with a complaint of headache and was treated with IM headache medications and sent home with a diagnosis of headache with pain meds. How …
Read MoreCoding by Time, for Emergent Care, and for Nurse Practitioner Visits
Q. How does one determine whether an E/M code can qualify for coding according to time spent? Obviously, any psychiatric counseling would fit the criteria, but what about “teaching” (e.g. how to use an inhaler, how to perform a breast exam), or preventive medicine counseling? – Question submitted by Dr. Kim, Med7 Urgent Care, CA A. The key issues on counting counseling or coordination of care toward the E/M code are: Counseling and/or coordination of …
Read MoreSplint Applications by Staff, and Proper Use ofModifiers -25, -26, and -59
Q. At the UCA Fall Urgent Care conference, you welcomed all questions, so here goes: Can you please let me know if it is appropriate to charge for Ortho-Glass and fiberglass splints in the urgent care setting? In some cases, the splints are applied by a tech under the direct supervision of the physician. In other cases, can the charge for the application of the splint be coded in addition to the Q code? Question …
Read MoreS9083 & Secondary Insurance, Laceration Repair, and More
Q. We bill S9083 to several carriers. Occasionally, a patient will have secondary insurance. If the primary insurance is contracted to pay S9083 code but transfers the balance to the deductible, how do we bill the secondary carrier if they do not accept the code? Question submitted by Paula Seify, Back Office MD A. Many secondary payors do not accept S9083, but these payors still will often cover the actual services that were rendered under …
Read MoreCoding for I&D, DTaP, and Procedures Included in the E/M Code
Q. An urgent care that I do billing for has presented a question I would like your input on. A sales rep has stated that urgent care centers are now administering DTaP in urgent care, and, if so, what is the difference between the reimbursement of the Td (90714) and the DTaP (90715)? Lynn Gray, Eastern Hills Medical Billing, Cincinnati, OH A. Patients may use urgent care centers when they have difficulty getting timely appointment …
Read MoreProper Use of 99051, and the Status of S9088
Q. Can I bill the CPT code 99051 (Services(s) provided in office during regularly scheduled, weekend, or holiday office hours, in addition to basic service) for the purpose of getting a denial? Can I bill a Medicare patient for the 99051 code if I have an advanced beneficiary notice (ABN) completed? Anonymous, Texas A. This is a very interesting question, and I am sure it will generate significant controversy. In regard to your question about …
Read MoreMedication Supplies, New Patient E/M, and Skin Shaving Vs. Skin Biopsy
Q. On our new superbill, there is a spot to code for Phenergan (generic is promethazine HCI) 50 mg when administered intramuscularly. How would we code for Phenergan when the physician orders Phenergan 25 mg IM? Do we mark the code x ½? Anonymous, Illinois A. If you administer 50 mg of promethazine or any portion of 50 mg, then you use code J2550 (injection, promethazine HCI, up to 50 mg). For example: 25 mg …
Read MoreCoding for Observation, and More on Established vs. New Patients
Q. Is it possible for observation status codes (99217-99220) to be billed in an urgent care facility? A. Observation codes will require the point of service (POS) to be a hospital. If your urgent care is operated by a hospital and you can legitimately use a hospital POS, then you may be able to use these codes. If you use the physician office (POS-11) or urgent care (POS-20) place-of-service codes, then you could not use …
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