CODING Q&A Of Discounts, Surgical Wound Dressing, and the S9088 Code ■ DAVID STERN, MD, CPC Q . For uninsured patients, how much discount should be given—70% off charges? Particularly in California. It would be extremely rare to offer such a big discount to self-pay patients. It would be unadvisable for the fol- lowing reasons: Ⅲ Unless your fee schedule is ridiculously high, you could not operate profitably at these discounts. Ⅲ Discounts should be given not for being self-pay, specif- ically, but for paying in full at time of service. Ⅲ You will need to watch out for accepting any fees that are below a Medicare fee schedule, as this may produce legal problems if you are participating in the Medicare program. A. Q . Using diagnosis code V58.31 (encounter for change or removal of surgical wound dressing), can we bill the following codes? Ⅲ A6407 packing strips Ⅲ A4209 syringes Ⅲ A4550 surgical trays Ⅲ A4322 irrigation Ⅲ A6245 hydrogel In general, these supplies are not billed by physician offices, as reimbursement for these codes is bundled into the fee for the actual CPT code of a procedure. These codes are usually billed by facilities (on the UB-04 form), where the relative value units (RVUs) for the procedure CPT codes are included. In the outpatient physician office setting (i.e., the setting for billing for most urgent care centers), there are several situations that will come into play when considering this issue: Ⅲ Recheck of a wound that was sutured (or had an incision A. David E. Stern, MD, CPC, is a certified professional coder. He is a part- ner in Physicians Immediate Care, operating 12 urgent care centers in Oklahoma and Illinois. Stern serves on the Board of Directors of the Ur- gent Care Association of America and speaks frequently at urgent care conferences. He is CEO of Practice Velocity (www.practicevelocity.com), providing urgent care software solutions to more than 500 urgent care centers. He welcomes your questions about coding in urgent care. w w w. j u c m . c o m and drainage [I&D]) and is still within the global period (usually 10 days) for the procedure. In this case, it would not be appropriate to bill any of these codes, as all rou- tine follow-up is included. Ⅲ Recheck of a wound that was repaired in another facil- ity. If you did debridement, I&D, or some other procedure, then these codes would be included in the code for the procedure. Ⅲ If you used these supplies, but it was not during the global period for a procedure done at your center and it was not part of a procedure, then you may be able to code for these supplies. Ⅲ If you used these supplies and all the following criteria ap- ply, then depending on the payor (but never for CMS pay- ors), you may code for these supplies: The visit was dur- ing a global period, it was associated with a complication of that procedure, and it was not associated with another billable procedure. NOTE: Just because you may compliantly code for certain supplies does not mean that a payor will actually reimburse for these supplies. Q . We are an urgent care center in Georgia. Thanks to your lecture at the UCAOA convention, we re- cently began using code S9088 to group health insurance with great success. Can we bill that code on every visit? If you meet the UCAOA definition of an urgent care center, then it seems appropriate to use the code for all visits. Exceptions might include: Ⅲ scheduled visits Ⅲ drug screen visits Ⅲ visits that do not involve the physician. Note: Some payors may refuse to pay on the code, and in the future some payors may ask you to reimburse them for the payments. If they do ask for reimbursement, you should see if they are allowed to do this by contract. At the very least, use this interaction as a starting point to educate the payor to the additional expenses and significant value of urgent care cen- A. 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 | S e p t e m b e r 2 0 0 8 41