CODING Q&A S Codes (S9088 and S9083) in Urgent Care ■ DAVID STERN, MD, CPC T he 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 speak- er and consultant on coding in urgent care, will offer answers to commonly asked questions in every issue of JUCM. In this issue, he delves into the sometimes confusing realm of the S codes. Q. What is an S code? S codes are a set of Healthcare Common Procedure Cod- ing System (HCPCS) codes that were originally request- ed by Blue Cross/Blue Shield. The codes are listed by the Cen- ters for Medicaid & Medicare Services (CMS), but they are never for use on claims filed to Medicare. A. Q. A. Does anyone besides Blue Cross and Blue Shield pay on S codes? Yes, many payors and agencies (including managed care organizations [MCOs] and state workers compensa- tion boards) have found these codes useful for defining specif- ic services that are neither recognized nor reimbursed by Medicare or Medicaid. S9083: Global Fee for Urgent Care Centers Q. What is S9083? This is used by payors to bundle all services rendered in an urgent care visit—whether it be for a hangnail or a A. 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.prac- ticevelocity.com), a provider of charting, coding and billing software for urgent care. He may be contacted at dstern@practicevelocity.com. 38 heart attack—into a single, one-size-fits-all global code for reimbursement with the same single flat-rate fee. Many MCOs in several states (e.g., Florida, California and Arizona) use this case-rate method to reimburse for urgent care visits. Urgent care administrators should point out to the MCOs that this case-rate reimbursement generally means that the urgent care center can take care of only minor ailments profitably. “Case-rate coding may force an urgent care center to send higher acuity cases to a hospital emergency department.” Case-rate coding works well for clinics that are equipped only to care for minor illnesses and injuries, such as colds, insect bites, and minor bruises. Many urgent care centers, however, are equipped to take care of many moderate acuity injuries and illnesses (e.g., dehydration requiring intravenous fluids, fractures, complicated lacerations, corneal rust rings, and others). Urgent care centers should make it clear to the MCO that using case- rate coding may end up forcing an urgent care center to send higher acuity cases to a hospital emergency department, where total fees will be up to 10 times more than if those same services were rendered in the urgent care center. Q. A. What should I do if the MCO insists on using S9083 for urgent care visits? Whenever possible, the urgent care center should work with the MCO to show that it is in everyone’s best interest to pay for services rendered, rather than resort to one-size-fits-all reimbursement. Some visits take 20 minutes of work; others take three hours of work. But if the MCO insists on only paying for 20 minutes worth of work, then the urgent care provider will need to refer more complicated cases to other JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | D e c e m b e r 2 0 0 6 w w w. j u c m . c o m