Journal of Urgent Care Medicine

Nine Recurring Coding Pitfalls for Urgent Care Clinicians to Avoid

Brad Laymon, PA, CPC, CEMC Over my career as a physician assistant, I have delved extensively into the intricacies of medical coding guidelines. Through collaborative initiatives with healthcare systems and fellow clinicians, I have been able to identify 9 common, recurring coding pitfalls. This process came with significant time and experience, and I want to share what I’ve learned as my ultimate objective has always been advancing charting accuracy to instill confidence among providers in …

How to Survive a Payer Review

Benjamin Barlow, MD; Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC One of the biggest challenges facing urgent care operators is increased scrutiny in the form of payer reviews. More clients than ever are facing these administrative and financial burdens. Compounding the issue is that urgent care clinicians often struggle to understand coding guidelines and how to document in a way that shows their medical decision making, which is vital in care and in payer reviews. Prepayment …

Charting with Purpose: Precision Strategies for Accurate Coding and Malpractice Defense

Jeff Willis, MD Urgent Message: A well-told story explaining your thought process during a patient encounter will contain all the elements required for accurate coding. Attorneys are less likely to question care when a logical and complete story is clearly documented. Citation: Willis J. Charting with Purpose: Precision Strategies for Accurate Coding and Malpractice Defense. J Urgent Care Med. 2024; 18(4) 13-16. As a medical legal consultant, I have learned medical malpractice claims are an …

The Importance of Providing Clinical History for Radiology Studies in the Urgent Care Setting

Morgan P. McBee, MD, CIIP; Leah S. McBee, MD Urgent Message: Urgent care clinicians need to provide relevant clinical history for radiology orders to ensure that the correct exam gets performed, an accurate ICD-10 code can be assigned for billing, and that radiologists are able to provide high-quality reports that contribute to timely and appropriate patient care in the urgent care setting. Citation: McBee M, McBee L. The Importance of Providing Clinical History for Radiology …

Identifying (and Resolving) Common Billing Pitfalls

Denials and rejections are inevitable in medical billing and can have drastic repercussions on the overall profit of an urgent care practice. Studies show almost 30% of medical bills are prone to errors. Avoid these common mistakes to improve the return on your investment. Eligibility Errors Avoidable eligibility errors are the biggest issue in urgent care billing. Over one-third of total visits with a rejection or denial are due to a lack of proper registration …

A New 4-Year-Old Patient with Fever and Sore Throat After a COVID Exposure

Bradley L. Laymon, PA-C, CPC, CEMC PRESENTATION A mother brings in her 4-year-old, who has never visited your urgent care center before, with complaints of fever and sore throat. The mother provides the HPI. She explains that the child’s symptoms have been present for 2 days. During that time, the patient’s temperature rose to a high of 101.5°F (38.6°C). Ibuprofen has been effective in reducing the fever. The girl was exposed to COVID-19 at daycare …

Hospitals Wave Red Flags as UnitedHealthcare ED Policy Takes Effect

UnitedHealthcare (UHC) just launched a new protocol for evaluating emergency room claims that it says will encourage accurate coding by providers and ultimately bring down healthcare costs. Some hospitals view it as just another way to deny claims, however—and one that could actually end up costing patients more money, at that. Under the policy that took effect on March 1, UHC reviews and maintains the right to adjust or deny claims for ED visits coded …

New Flu Vaccine Codes—and an Update on Proposed Changes to the E/M Guidelines

Q: Do you have information on the 2017-2018 influenza vaccine codes? A: The American Medical Association (AMA) recently published a list of new and revised vaccine codes on their website (https://www.ama-assn.org/sites/default/files/media-browser/public/cpt/vaccine-long-desc-july-2017.pdf). These codes will be published in the 2018 Current Procedural Terminology (CPT) manual. The two new influenza vaccines on the list are: 90682, “Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use” 90756, …

Maximize Revenue for Nebulizer Treatments

Q: What can we bill for when we give a patient a nebulizer treatment for an acute airway obstruction during an exacerbation of asthma, or wheezing due to an upper respiratory ailment? A: You can bill for the service and the medication. However, depending on the payer rules, the medication might be bundled into the service. Time is a factor when billing the service. If the treatment is less than 1 hour, you would bill …

2018 ICD-10-CM: A Preview of Urgent Care-Relevant Changes

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 …

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