Journal of Urgent Care Medicine

ICD-10

Q. My staff keeps telling me that my documentation will have to change in order for them to properly choose an ICD-10 diagnosis code. Is that true? A. Documentation practices should not have to change but it will be helpful to understand the granularity of the new codes. There is greater specificity including laterality, temporal factors, contributing factors, symptoms, manifestations, and anatomic location. Thus, if you currently gloss over details in the medical record, you …

ObamaCare Update or Fear and Loathing: The Affordable Care Act

JOHN SHUFELDT, MD, JD, MBA, FACEP In the conclusion of my October 2012 column on ObamaCare I wrote that no matter the outcome (of the presidential election) our future will not be boring. Fourteen months later, it has not been boring and we are just around the corner from imposing the individual mandate (aka tax penalty) on those who don’t have minimal insurance coverage. However, before we cross the starting line let’s review a bit …

Identifying Risks and Finding Shelter in an Urgent Care Compliance Program

Urgent message: The escalating pressure on the industry to decrease health care costs has resulted in an increase in audit activity from government and private payors for everything from billing and coding to HIPAA and kickbacks. Therefore, it’s more important than ever for urgent care centers to build a culture of compliance. DAMARIS L. MEDINA The health care industry is in the throes of a dynamic regulatory enforcement climate. Federal and state regulators and third-party …

Developing Data: December, 2013

These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care). In …

2014 CPT Changes, Suture Removal, Place of Service Code

DAVID STERN, MD (Practice Velocity) Q. I understand that we will be able to bill for cerumen removal for both ears in 2014. Is that true? A.Yes. In 2014, you will be able to bill CPT code 69210, “Removal impacted cerumen requiring instrumentation, unilateral” with modifier -50, “Bilateral procedure.” Keep in mind, Medicare will typically not cover simple, non-impacted earwax removal. CMS requires that physicians meet the following criteria for reimbursement of the removal of …

Help me understand…

JOHN SHUFELDT, MD, JD, MBA, FACEP lease don’t share this with anyone but truth be told, I love paramedics. I sometimes thought I had it bad (I really didn’t think that, but it makes the story better if I sound tragic) treating the myriad disenfranchised in an inner city ED until I talked with the paramedic who wrestled the feces-covered, bath salts and meth-using, naked, combative maniac who was my patient the previous night. (The …

Improving Urgent Care Center Profitability Through Medical Supply Management and Accounting

Urgent message: Many urgent care centers lack an inventory management process and do not accurately account for their utilization of supplies. Improving how a center manages and accounts for supplies can have a direct impact on the bottom line. ALAN A. AYERS, MBA, MAcc Practice Velocity Introduction A quick and easy way to improve your urgent care center’s profitability may be as close as your supply closet. Many urgent care centers lack defined processes for …

Developing Data: November, 2013

Coding Intravenous Infusions with Hydration; Medical Decision Making

DAVID STERN, MD (Practice Velocity) Q. We perform a lot of IV infusions in our urgent care facility. Sometimes we also perform IV pushes and hydration at the same time as the infusion. We have been billing CPT codes 36000, 96365 -59, 96360 -59, and 96374 -59. Medicare pays for these codes when we append the -59 modifier but I am concerned that this may not be the correct way to bill after reviewing some …

Using Physician Extenders

JOHN SHUFELDT, MD, JD, MBA, FACEP You breathe a deep sigh of relief after learning that you were not the treating provider of a patient who came into your urgent care center and had an unexpected bad outcome. The patient was seen by your mid-level provider who works on opposite days from you in your center. As documented in the medical record, the patient sounds benign: a 28-year-old female who presented with continued sinus symptoms …