MDM, E/M Code with Injection Codes

Q. I was approached by a member of the hospital billing department who does urgent care (office based practice) and emergency department billing about a coding question. As the medical director, they asked for my thoughts and support. It’s nice to work at a place that includes the docs! The question revolves around prescription drug management within the management options under the medical decision making (MDM) section pertaining to E/M calculation. We currently do not …

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Medical Malpractice Insurance: Read the Fine Print

JOHN SHUFELDT, MD, JD, MBA, FACEP Our emergency medicine group was informed that a new corporate mandate will force us to nearly double our malpractice coverage from $1 million for each occurrence and $3 million in yearly aggregate ($1M/$3M) to $2M/$4M. This mandate came despite our group’s low malpractice claims history, a higher burden of proof for plaintiffs in the state where we practice, and a very “doctor-friendly” malpractice environment in our county. To my …

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Marketing Strategies: School, Sports, and Camp Physicals

Marketing Strategies: School, Sports, and Camp Physicals

Urgent message: Sports physicals offered by an urgent care center can be a “win” for both the center and the community. The community gets a flexible source for a time-critical service and the center gets another way to attract new and repeat business. ALAN A. AYERS, MBA, MAcc Practice Velocity Schools, camps, inter-league and club sports programs typically require a pre-participation physical examination to evaluate a participant’s general health, fitness level, risk of injury and …

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What Percentage of Patients Do Urgent Care Centers Assist in Finding a Primary Care Physician?

  These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care).

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Urgent care codes, E/M Guidelines, ICD-10

Q. Is there a defined set of diagnosis codes for urgent care services and is there a diagnosis code that indicates the services were urgent? A. All facilities use the same set of ICD-9 codes to report the patient’s diagnosis. There are no diagnosis codes to represent urgent care services, but there are certain procedure codes you can use to indicate that services were rendered in an urgent care clinic and also procedure codes to …

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Malpractice Trends in Urgent Care and Retail Medicine

JOHN SHUFELDT, MD, JD, MBA, FACEP with ANDREW SNIEGOWSKI, RN, JD CANDIDATE 2014 Over the last 6 years I have written a number of articles on medical malpractice in urgent care medicine. The good news is that I am seeing fewer cases despite the fact that there are more urgent care centers and more patient visits. The bad news is that I am still seeing the same fact patterns time and again. Failure to diagnose …

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Expert Perspectives on Grassroots Marketing in Urgent Care

Expert Perspectives on Grassroots Marketing in Urgent Care

Urgent message: Grassroots marketing tactics can be effective in engaging a center’s providers and staff with the communities they serve while also educating prospective patients about the availability of urgent care. Introduction This roundtable focuses on grassroots marketing for urgent care centers, which differs from traditional advertising in that it involves more interaction with prospective patients and requires a hands-on approach to building relationships and spurring word-of-mouth in the community. The panel of experts we’ve …

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Developing Data: February, 2014

These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care).

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Pulse Oximetry, Oral Medication

Q. I am reviewing documentation for a freestanding urgent care center that performs pulse oximetry on every patient they see, regardless of the reason. Is this typical? In some cases, they are billing the case rate code, S9083. Please let me know if this is standard operating procedure. A.Medicare will allow payment for pulse oximetry under two conditions: 1) when it is linked to an appropriate diagnosis code; and 2) if it considered as being …

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Treating the Self-Harming Patient in the Urgent Care

Treating the Self-Harming Patient in the Urgent Care

JOHN SHUFELDT, MD, JD, MBA, FACEP He watched her walk through the door at the end of a long, busy day. She was an attractive, well dressed, athletic-looking young lady with a warm smile, the kind of girl he’d want his teenage son to date someday. “Slam dunk,” he thought. “This will be a quick visit and I’ll still get out on time.” The front office team registered her quickly. He suspected that they, too, …

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