Journal of Urgent Care Medicine

Denial Rate Low—But Costly—4 Months Into ICD-10

The denial rate for claims initiated after the crossover from the ICD-9 system to ICD-10 codes in October has been steady—and lower than hysterics predicted it would be—if the 262 million claims processed by one company are any indication. RelayHealth Financial, a revenue cycle management provider, found a denial rate of 1.6% in each month from November 2015 through the first 3 weeks of February 2016. That reflects claims involving 630,000 healthcare providers. The financial …

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 …

New vs. Established Patients, Medicare Exam, ICD-10 Delay

Q. A patient with Medicare as his primary insurance needs a physical and EKG for clearance for an MRI with sedation ordered by his neurologist. Symptoms are imbalance along with pain in the shoulder, neck, and upper spine. Can I use the pre-op code V72.81 because there is sedation even though there is no actual surgery? Or should I just get a signed Advanced Beneficiary Notice (ABN) and expect a denial? A. Yes, you can …

Developing Data: January, 2013

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 UCAOA 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). In …

ICD-9 Changes in 2008

DAVID STERN, MD (Practice Velocity) Q.I noticed that I am getting rejections for the code for fever (780.6). Do I need to add another diagnosis code to get paid? A.There are numerous separate issues related to this code: First, every year ICD-9 updates go into effect on Octo- ber This year was no exception. This code is now sub- categorized as follows: 60 Fever, unspecified 61 Fever presenting with conditions classified elsewhere 62 Postprocedural fever …