Journal of Urgent Care Medicine

Get the Most Out of Providing Medicare Wellness Exams

Q: Are there specific requirements for Medicare wellness exams and who can perform them? A: Medicare offers an initial preventive physical examination (IPPE), which is also known as the “Welcome to Medicare” preventive visit or the annual wellness visit (AWV). Either a physician (a doctor of medicine or osteopathy) or a qualified nonphysician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist) can provide the services. The IPPE is a one-time initial examination …

2018 Current Procedural Terminology (CPT) Code Changes

There are 314 code changes in the CPT manual for 2018, with 172 new codes, 60 revised codes, and 82 deleted codes. Most of the changes affect surgery procedures, but the updates include several changes that are relevant to urgent care. For your convenience, we have listed these changes in expected relevance to urgent care: Radiology Codes for x-rays of the chest and abdomen have been deleted and replaced with codes based on the number …

New Flu Vaccine Codes—and an Update on Proposed Changes to the E/M Guidelines

Q: Do you have information on the 2017-2018 influenza vaccine codes? A: The American Medical Association (AMA) recently published a list of new and revised vaccine codes on their website (https://www.ama-assn.org/sites/default/files/media-browser/public/cpt/vaccine-long-desc-july-2017.pdf). These codes will be published in the 2018 Current Procedural Terminology (CPT) manual. The two new influenza vaccines on the list are: 90682, “Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use” 90756, …

When Billing by Exam Type, the Revenue Is in the Details

Q: What is the difference between a detailed exam and an expanded problem-focused exam? A: Unfortunately, there is no straightforward answer to that question. The Centers for Medicare and Medicaid Services (CMS) provides some guidance in the 1995 and 1997 guidelines (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243514.html). The 1995 guidelines state the documentation of the examination as follows: Problem-Focused – A limited examination of the affected body area or organ system. Expanded Problem-Focused –A limited examination of the affected body …

Optimizing Tax ID Numbers, and Coding for Health Risk Assessments

Q: We are planning to open a new clinic that will offer both primary care and urgent care services. Can we use the same tax identification number (TIN) when we start negotiating contracts with insurance payors? A: Based on our experience with doing this many times, if you attempt to use the same TIN for both primary care (PC) and urgent care (UC), you are likely to see the following results: Some payors are likely …

Helping Workers Take Ownership by Giving Them Ownership

Many urgent care operators work hard to get their employees to take ownership of their jobs. Now one of the key stakeholders in the growth of the urgent care industry has taken those efforts to the next level by literally making employees partial owners of the company they work for. Practice Velocity CEO David Stern, MD surprised employees at a recent town hall-style meeting by telling them how much he appreciates the positivity they bring …

Splint and Cast Application Performed by Someone Other than Physician

Q: Can you bill for splint and cast applications done by someone on staff other than the physician? A: Yes, you can still bill for the service if the application is performed by someone else in the clinic. The American Medical Association (AMA) provided guidance on this in the Current Procedural Terminology (CPT) Assistant, April 2002 issue: “You will note that the reference to ‘physician’ has been retained in the clinical examples provided. This inclusion …

Understand the Rules—and Code Correctly—When Charging a Facility Fee

Whether an urgent care can bill Place of Service -19 or -22 requires an understanding of the criteria enabling facility code sets. An urgent care joint venture between physicians and a hospital recently inquired about using Place of Service 22 (Outpatient Hospital), enabling facility fees. The key with billing the urgent care as “outpatient hospital” is that it must truly qualify for that service. I have reservations as to whether the urgent care could bill …

The Effects of the National Correct Coding Initiative

Q. I understand that the Centers for Medicare & Medicaid Services has added National Correct Coding Initiative (NCCI) edits that no longer allow the billing of debridement with hundreds of surgical codes. What is the impact? How do NCCI edits affect us in general? A. NCCI edits define when two procedure codes may not be reported together except under special circumstances. Medicare implemented NCCI to promote national correct coding methodologies and to control improper coding, …

ICD-10-CM and ICD-10-PCS Changes Effective October 1, 2016

Because it has been 4 years since the last annual update of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and because 2016 is the first year for the Centers for Medicare & Medicaid Services (CMS) to make updates to ICD-10-CM, CMS made many edits to the classification’s code set. On October 1, 2016, International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) will include 3651 new codes and 487 revisedcodes,1 and …

« Previous