Coding Q&A

It’s again time to review what has changed with the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) effective October 1, 2017 through September 30, 2018. There are 360 new, 142 deleted, and 226 revised diagnosis codes in the final update. We will review the changes most relevant to urgent care, but the examples shown here are not all-inclusive. You can find all updates in the Centers for Medicare and Medicaid Services (CMS) website at Enterocolitis Code A04.7 was deleted to make room for two new codes thatRead More
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 ( 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 area or organ system and other symptomatic or related organ system(s). Detailed – An extendedRead More
Q: We had a patient present with multiple lacerations and were wondering how to bill, since some were repaired with sutures and some were repaired with staples. A: Laceration repair is billed based on the complexity, length of the repair, and the anatomic site. The repair can consist of sutures, staples, or wound adhesive (eg, Dermabond). The Current Procedural Terminology (CPT) manual classifies the complexity of the repair of wounds as being simple, intermediate, or complex. Simple repair is used when the wound is superficial, primarily involving epidermis, dermis, orRead More
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 to refuse to give both contracts to the same entity. Some will be fine withRead More

Posted On March 27, 2017 By In Coding Q&A

Coding for Critical Care Services

Q: Can we bill for critical care services when spending extra time with patients who are very ill? A: It is rare that you would perform billable critical care services in the urgent care setting. According to the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA), critical care is defined as the direct delivery by a physician(s) of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there isRead More
Q: We are coding for an urgent care group that is owned by a hospital and bills on a CMS-1500 for professional services and the UB-04 for facility services. We bill using Place of Service (POS) code 22. Is this correct? A: Prior to January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) POS code set did not differentiate between an urgent care operating on campus or off campus. As of January 1, 2016, the criteria for outpatient hospital services have changed. If the hospital elects to billRead More
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 does not infer that the cast/splint/strap procedure was performed solely by the physician, as nursesRead More
A new year always brings changes, and CPT is not excluded. On January 1, 2017 you will want to take note of CPT code changes that will affect your billing. Imaging Guidance Codes with Puncture Aspiration If guidance is used for needle placement when performing puncture aspiration CPT code 10160, “Puncture aspiration of abscess, hematoma, bulla, or cyst,” coders are directed to the imaging guidance codes: 76492, “Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) imaging supervision and interpretation” 77002, “Fluoroscopic guidance for needle placement (eg, biopsy,Read More