David Stern, MD, CPC
The urgent care practitioner may not live by coding alone, but
proper reimbursement depends on it. To that end, Dr. David
Stern, a certified coder who is in great demand as a speaker
and consultant on coding in urgent care, will offer answers
to commonly asked questions in every issue of JUCM.
In this issue, he addresses a potpourri of issues raised by
urgent care practitioners.
Q. A consultant tells us that we have to use the new
codes for type B emergency departments. We are
owned by the hospital, but are off campus and do not
advertise ourselves to be an emergency department.
Are we a type B emergency department?
A. There has been a lot of confusion about type B emergency
departments this year. Some consultants have
been telling urgent care administrators that they are a hospitalowned
urgent care center, so they are a type B emergency
department. Simply being hospital owned, however, is not
adequate to meet the specific criteria outlined by the Centers
for Medicare & Medicaid Services (CMS).
To be a type B emergency department, your center must
meet one of the following criteria:
It is licensed by the state in which it is located under
applicable state law as an emergency room or emergency
department. [Unless your center is licensed as an
emergency department, this does not apply.]
It is held out to the public by name, posted signs, advertising,
or other means as a place that provides care for
emergency medical conditions on an urgent basis without
requiring a previously scheduled appointment. [Rarely does
an urgent care clinic hold itself out to the public as treating
“emergency conditions.” Rather, almost all urgent care centers
tell the public specifically that their centers are not
appropriate for evaluating or treating true emergency conditions.
Instead, most urgent care centers tell the public to go
to a hospital emergency department or to call 911 if the
problem is thought to be a true emergency.]
During the calendar year immediately preceding the calendar
year in which a determination under this section is
being made based on a representative sample of patient
visits that occurred, at least one-third of all outpatient visits
to the urgent care center are for the treatment of
emergency medical conditions on an urgent basis without
requiring a previously scheduled appointment. [Very,
very few urgent care centers treat over one-third of their
patients for true emergency conditions. Some hospital emergency
departments may not even meet this criterion.]
Very few urgent care centers will meet any of the above three
requirements, and thus they should not be classified as type B
emergency departments.
Some confusion may arise from the third criterion. There are
three parts, however, to this final criterion, and your center must
meet the definition in all three parts (not just one or two parts)
to qualify as a type B emergency department. So, if we evaluate
all three parts, the question is this: Are over 1/3 of the visits
to your center:
on an urgent basis
without appointment
and for treating emergency medical conditions?
Many urgent care centers may answer “yes” to the first
two components, but for the majority of true urgent care centers,
the answer to the last question is almost always “no.”
Hence, they do not qualify as type B emergency departments.
Q. We frequently remove cerumen from the ears of
patients in our urgent care center. We use different
methods for removing the cerumen, including irrigation, spoon, loop, or forceps.
When can I use CPT code 69210, “Removal impacted
cerumen (separate procedure), one or both ears”?
A. CMS limits the use of 69210 for cerumen removal to visits
that meet all of the following criteria:
Cerumen removal is the only reason for the visit.
Cerumen removal is personally performed by a physician
or midlevel provider.
The patient is suffering symptoms from excess cerumen.
Removal requires more than drops, cotton swabs, and
cerumen spoon.
Chart documentation shows that the procedure required
significant time and effort.
CPT, however, does not specify what method is used for cerumen
removal, and many payors use different guidelines for coding
for cerumen removal. You may want to check with individual
payors to determine their policies for using this code.
Q. What code should I use for destruction of plantar
warts or molluscum contagiosum?
A. The codes for lesion destruction have been changed for
2007. You should now use CPT codes 17110 and 17111 for
destruction of common or plantar warts. These codes—17110
and 17111—have been revised to include destruction of benign
lesions other than skin tags or cutaneous vascular lesions. Codes
17000 and 17003 now exclude destruction of benign lesions.
Q. How should I code for a fracture of the distil
radius that includes a fracture of the ulnar styloid?
A. 2007 revision to CPT code 25600 for closed treatment
of a distal radial fracture now states that this code “includes
closed treatment of fracture of ulnar styloid, when performed.”
Thus, both fractures are bundled into the same code (25600).
Q. Allergists sometimes send patients to us for allergy
shots. If we give two allergy shots to a patient
on the same day, should I add code 95117 to 95115 or
should I use just 95117?
A. Use CPT code 95115 for a single injection on a given date.
If you administer more than one allergy injection (two,
three, or even 10 allergy injections) on a single date, then
code only a single code 95117.
Note: CPT codes, descriptions, and other data only are copyright 2007 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
Disclaimer: JUCM and the author provide this information for educational purposes only. The reader should not make any application of this information without consulting with the particular payors in question and/or obtaining appropriate legal advice.
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David Stern is a partner in Physicians Immediate Care, with nine urgent care centers in Illinois and Oklahoma, and chief executive officer of Practice Velocity (www.practicevelocity.com), a provider of charting, coding and billing software for urgent care. He may be contacted at
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