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 …
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Understand the Rules—and Code Correctly—When Charging a Facility Fee
Whether an urgent care can bill Place of Service -19 or -22 requires an understanding of the criteria enabling facility code sets. An urgent care joint venture between physicians and a hospital recently inquired about using Place of Service 22 (Outpatient Hospital), enabling facility fees. The key with billing the urgent care as “outpatient hospital” is that it must truly qualify for that service. I have reservations as to whether the urgent care could bill …
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October 2016
Plantar Warts, Digital Nerve Block in Lacerations, and Established Patients
Q. We had a patient present with 12 plantar warts. The provider used liquid nitrogen to freeze all 12 of the warts. What code should I bill for this procedure? A. In this case, you would bill Current Procedural Terminology (CPT) code 17110, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.” Use only code 17110 once because the …
Read MoreFracture Care
Q. Will you please help me understand initial visit, subsequent visit, and sequelae related to fracture care? If the patient is treated elsewhere for a fracture and the provider just stabilizes the fracture and instructs the patient to then come to my office for reduction, is this a subsequent visit or an initial visit? A. International Classification of Diseases 10th Revision, ClinicalModification (ICD-10-CM) guidelines state that a seventh character, A, is used for the initial …
Read More2016 Current Procedural Terminology Changes Pertinent to Urgent Care
Evaluation and Management There were two revisions and two additions to the “Evaluation and Management” section. Add-on codes 99354, “Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour,” and 99355, “. . . each additional 30 minutes,” were revised to add the term psychotherapy in the description. Some good news in …
Read MoreSame or Similar Diagnoses for Follow-Up Visits
Q. Is there a global period for the diagnosis used for follow-up on an evaluation and management (E/M) code when there is not a change in the chief symptom? We had a patient with a skin irritation for which the provider prescribed a hydrocortisone cream for the diagnosis of “dermatitis, unspecified” (L30.9). The provider instructed the patient to return in 1 week if the condition did not clear up. The patient returned 3 days later …
Read MoreUnspecified Diagnosis Codes, Preoperative Examinations, and Tuberculosis Skin Tests
Q. We are afraid of getting denials for using unspecified ICD-10-CM [International Classification of Diseases, 10th Revision, Clinical Modification] codes. In an urgent care center, we sometimes will see a particular patient only one time for minor illnesses and injuries, and follow-up with their primary-care physician is always advised. Do you have any advice on documenting to get claims paid? A. Within ICD-10-CM, you may select codes defined as “Not Otherwise Specified” (NOS). Generally, this should …
Read MoreTravel Immunizations
Q. What is the best way to code for and bill patients who come in because they are planning to travel out of the country and need to know what immunizations they should have before traveling? We advise them on preventive measures to take in relation to where they are traveling, provide literature if appropriate, and even try to find health-care facilities close to where they will be staying while abroad. I know we can …
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October 1: Out with ICD-9, in with ICD-10
“Urgent care” was in its infancy and electronic medical records were practically the stuff of science fiction when the ICD-9 codes were released in 1979. The Centers for Medicare and Medicaid Services (CMS) takes one giant leap toward catching up with the launch of ICD-10 codes on October 1. As of that date, ICD-9 codes will no longer be accepted. CMS has said the new coding set is expected to “advance public health research and …
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