Journal of Urgent Care Medicine

Medical Necessity in E/M Coding

DAVID STERN, MD (Practice Velocity) Q.Recently some of my charts were audited and the payor challenged the levels of the evaluation and management (E/M) codes I had used. The payor said that the charts were actually coded correctly, based on the information that was documented on the chart. The auditor, however, challenged what she called the “medical necessity” of the documentation. She claimed that, based on the patients’ chief complaints, many elements of the E/M …

Malpractice Insurance: A Primer for Urgent Care Clinicians

JOHN SHUFELDT, MD, JD, MBA, FACEP The possibility of being sued for medical malpractice, while not a pleasant prospect, is not something that should be causing you sleepless nights. Much like flood insurance, malpractice insurance exists for times when an unexpected event occurs and may require some payment for damages. Your goal should simply be to have adequate coverage for those times. And, let’s face it, there may be such times. Good providers do get …

Enhancing Profits with Immigration Physicals

Urgent message: Conducting immigration physicals can be surprisingly lucrative. These relatively high-priced, cash-only visits incur no insurance billing or accounts receivable carrying costs. And because they are scheduled, ebbs and flows in patient volume can be leveled. Here’s how it works. Alan A. Ayers, MBA, MAcc Practice Velocity The success of a new urgent care center in a community requires a change in consumer behavior, with a sufficient number of residents shifting their utilization from …

Developing Data: April, 2011

In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we offer a first look at data from the 2010 Urgent Care Benchmarking Survey Results. The data are based on the responses of 209 U.S. urgent care centers, 78.8% of which were UCA members. The survey was limited to “full-fledged urgent care centers,” the qualifications of which included accepting walk-ins during all hours of …

S9088 Coding for Medicare or Medicaid, Coding for SVT, and Coding 99211

DAVID STERN, MD (Practice Velocity) Q.In one of your articles concerning the S9088 code (services provided in an urgent care center), you indicate this code cannot be billed to Medicare or Medicaid. However, I read in another source that S9088 and S9083 (global fee for urgent care centers) had been approved by the Centers for Medicare and Medicaid Services (CMS) for billing these services. What is the current status of these codes as they relate …

Using Workplace-based Education as a Marketing Tool

Offering a key decision-maker a tour of your facility is often helpful in signing a new client. But what about the scores of individuals who work for that company? They’re not likely to come traipsing through your clinic en masse, hungry to learn about your services. Remember what the infamous criminal Willie Sutton said when a reporter asked him why he robbed banks: “That’s where the money is.” Similarly, if you want to reach the …

Competitive Analysis to Stand Above the Crowd

Urgent message: Providing high-quality care and good service is not necessarily enough to attract and keep patients, especially if those patients can take their pick from among several urgent care centers. More and more, urgent care operators need to be aware of how their competitors operate. Alan A. Ayers, MBA, MAcc Practice Velocity All too often, urgent care entrepreneurs operate in a vacuum. They feel that if they offer a well-appointed facility with good signage, …

Developing Data: March, 2011

In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we offer one more snapshot of data presented in a Health Affairs article entitled Many Emergency Department Visits Could Be Managed at Urgent Care Centers and Retail Clinics,1 in which prescribing trends in the urgent care setting are compared with trends in other settings, such as the emergency room and retail clinics. Below, we …

Coding Concerns: Versajet Debridement, Time Frame for New/Established Patients, Detailed Exams, Denial of S9088, –57 Modifier, and Billing for Injections

DAVID STERN, MD (Practice Velocity) Q.How do I code when using Versajet to debride an ulcer? A.For Versajet debridement, you should report CPT code 97597 (removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or …