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A new study suggests there has been a rise in higher acuity coding across certain outpatient services. Among urgent care centers, the proportion of visits coded at higher complexity levels (CPT 99204 and 99205) increased overall from 34.0% in 2018 to 40.6% in 2023, while visits coded at level 1 (CPT 99202) declined from 9.5% to 2.9% over the same period. The most significant increases in high-intensity coding were observed in cases involving “blood and immune disorders” (increasing from 42.7% to 61.6%) and “circulatory system diseases” (from 40.5% to 59.4%), according to the report by Trilliant Health. Higher coding for visits including injury and poisoning rose from 30.1% to 33.6%. By comparison, emergency department visits coded as level 4 (CPT 99284) rose from 32.5% to 39.6%, suggesting a broader shift toward higher-acuity patients or—as the study suggests—higher-acuity coding. For physician office visits, level 4 coding also increased, from 38.5% to 45%.
What are you seeing in your urgent care? On the ground, this reported rise in higher-level coding may reflect more patients presenting with complex or urgent medical needs, especially in areas that have witnessed hospital closures. At the same time, Americans are aging and primary care is becoming more difficult to access. Read more about high-acuity, low-occurrence presentations vs high-occurrence, low-acuity presentations in urgent care from the JUCM archive: The Quality of Urgent Care Depends on our Commitment to HOLA Expertise