Journal of Urgent Care Medicine

Coding 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 …

Modifiers for E/M Codes During Global Periods

Q. What is the official definition of “global period” as it applies to procedures in the urgent care center? When can we code an E/M in addition to the procedure? A. The actual definition of the global period differs slightly when it is defined by the AMA (CPT) and when it is defined by CMS (Medicaid/Medicare). CPT codes are published and copyrighted by the AMA. According to CPT as it applies to services rendered in …

An Update on New vs. Established Patients

David Stern, MD Q.I read your column about new vs. established patient coding in the January Issue of JUCM. Although the information provided was correct at one time, I believe that Medicare has updated its algorithm to come closer to the algorithm provided by AMA for new vs, established patients. A.You are correct. In a somewhat obscure and rarely referenced information release. (www.cms.hhs.gov/MLNMattersArticles/downloads/MM4032.pdf) CMS did change its position on this issue. “Physicians should not that …

Determining New vs. Established Patients for E/M Coding

Q.We are in the process of adding urgent care services to our occupational medicine clinic. How do we determine when to use a new or established E/M code for the patients who are seen for urgent care services? A.I continue to receive questions regarding the “when to code new or established patient E&M codes” conundrum, so let’s try to simplify the issue. The official CPT definition of new patient is: A patient who has not …

Coding Symptoms of Infections, Modifiers for X-rays, and Counseling Family Members

DAVID STERN, MD (Practice Velocity) Q.Our doctor saw a patient for a sore throat. The rapid strep screen was positive, so she placed the following diagnoses on the chart: 0: Streptococcal sore throat 61: Fever presenting with conditions classi- fied elsewhere 1: Throat pain 79: Other malaise and fatigue I told her that since we had a specific infection that was the cause of second, third, and fourth diagnoses, we should code the confirmed infection, …

ICD-9 Changes in 2008

DAVID STERN, MD (Practice Velocity) Q.I noticed that I am getting rejections for the code for fever (780.6). Do I need to add another diagnosis code to get paid? A.There are numerous separate issues related to this code: First, every year ICD-9 updates go into effect on Octo- ber This year was no exception. This code is now sub- categorized as follows: 60 Fever, unspecified 61 Fever presenting with conditions classified elsewhere 62 Postprocedural fever …

Nebulizer Treatment Coding and Take-backs on 99051

DAVID STERN, MD (Practice Velocity) Q.Payors do not seem to want to pay on the code E0572 (aerosol compressor, adjustable pressure, light duty for intermittent use). What can we do to get payment? A.This code is not for simple use of the aerosol compressor, but is actually used to code for sale of the actual nebulizer machine. Thus, this code would rarely be appropriate for use in the urgent care setting. Q.How do we get …

Of Discounts, Surgical Wound Dressing, and the S9088 Code

DAVID STERN, MD (Practice Velocity) Q.For uninsured patients, how much discount should be given—70% off charges? Particularly in California. A.It would be extremely rare to offer such a big discount to self-pay patients. It would be unadvisable for the following reasons: Unless your fee schedule is ridiculously high, you could not operate profitably at these Discounts should be given not for being self-pay, specif- ically, but for paying in full at time of You will …

Choosing the Right Fee Schedule— and the Right Resource

DAVID STERN, MD (Practice Velocity) Q.My office has started to provide urgent care. Should these services be reimbursed at a higher price than for our family practice services? Is there a different fee schedule? Question submitted by Nicole Phelps, First Health Medical, Fresno, CA A.Here is the scoop on coding and reimbursement for urgent care: Some payors will pay more for urgent care services over primary care services, but you will almost cer- tainly need …

Proper Coding for Skin Tag Removal, Workers Comp Issues, and Off-Hour Visits

DAVID STERN, MD (Practice Velocity) Q.Are you able to bill the following two codes together with a modifier: 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) 17111 (15 or more lesions)? – Question submitted by Julie Briggs A.These are mutually exclusive codes. You can use 17110 if the physician destroys 14 or less benign lesions (usually warts). …