Journal of Urgent Care Medicine

Abstracts in Urgent Care – January 2025

Hematoma Blocks Effective for Closed Forearm Reduction Take Home Point: Hematoma blocks are an effective method of achieving analgesia to facilitate closed reduction of forearm fractures. Citation: Pitman G, Soeyland T, Popovic G, et al. Hematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study. Emerg Med J. 2024; 41:595–601 Relevance: Adequate closed reduction of wrist and forearm fractures acutely after injury is important to reduce risk of complications …

16-Year-Old With Rash After Septoplasty

A 16-year-old girl presents to urgent care with complaints of fever, chills, and a diffuse sunburn-like rash that developed over the past day. The patient underwent septoplasty 2 days prior for a deviated septum, and nasal packing was utilized to manage her postoperative bleeding. On examination in urgent care, she was febrile to 104°F (40°C), tachycardic, and hypotensive. Widespread erythematous blanching macules and patches were seen. View the image below and consider what your …

Managing Health Data Obsessive Disorder Presentation in Urgent Care

In a prior editorial, I described the case of Thomas, a young man among the “worried-well,” who presented to urgent care (UC) with anxiety related to an alarm that sounded as a result of a malfunction of a continuous glucose monitor (CGM), which was prescribed despite his lack of a diagnosis of diabetes, out of concern for abnormal blood glucose levels.[1] The underlying issue prompting his visit was not hypoglycemia but what I refer to …

What’s New in Telemedicine for 2025?

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC The American Medical Association (AMA) added a Telemedicine Services category to the Evaluation and Management (E/M) section of the Current Procedural Terminology (CPT) code set. Codes are divided up by the technology used and the patient type (ie, new vs. established). These codes are for synchronous, real-time interactive encounters between the provider and the patient. Codes are leveled by medical decision making (MDM) or time, which is similar …

Urgent Care Assessment of Patients with Possible Diverticulitis

Urgent Message: Diverticulitis is a prevalent condition characterized by localized inflammation most commonly of the sigmoid colon. It is often diagnosed with a computed tomography scan with intravenous contrast. Uncomplicated cases are most common and require only monitoring, however complicated cases can require hospitalization and emergent surgical intervention. Urgent care clinicians should be comfortable assessing patients with possible diverticulitis and recognizing features that suggest the possibility of more complicated disease. Naushair Hussain DO; Shahmeer Hussain …

Rural Urgent Care Growth Continues, But Challenges Remain

Urgent Message: Rural urgent care is the industry’s fastest growing segment, influenced by rural primary care shortages, hospital closures and extended ED wait times, but operational staffing and reimbursement complexities must be navigated. Alan A. Ayers, MBA, MAcc Citation: Ayers A. Rural Urgent Care Grows, But Challenges Remain. J Urgent Care Med. 2024; 19(3): 17-21 As access to care in rural areas continues to decline, urgent care (UC) can play a pivotal role in the …

Urgent Care Diagnosis and Management of Midshaft Ulnar (Nightstick) Fractures

Urgent Message: Fractures of the midshaft ulna, commonly referred to as “nightstick fractures,” typically occur after direct injury to a forearm outstretched above the head as a protective mechanism. Evaluation includes inquiry into the circumstances of the assault, assessment for any other areas of trauma, examination of the skin, wrist and elbow joints, and radiography of the forearm. Management of closed, nondisplaced midshaft ulnar fractures centers around splint immobilization and arrangement of appropriate follow-up. Chandrika …

55-Year-Old With Wrist Pain

A 55-year-old woman presents to urgent care complaining of pain when she moves her right wrist. She reports the pain began suddenly when she woke up that morning without any known trauma. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.

Abdominal Pseudohernia and Urinary Retention Due to Spinal Nerve Root Compression From Disc Herniation: A Case Report

Urgent Message: Abdominal pseudohernia is a rare diagnosis with variable presentation. Urgent care clinicians who are familiar with the condition and its variable presentations can reduce the risk of diagnostic errors and unnecessary or inappropriate diagnostic testing. Berkeley E Prewett, BSA; Stephen V Green, MD; Andrew L Juergens II, MD; Taylor K Ratcliff, MD Citation: Prewett BE, Green SV, Juergens AL, Ratcliff TK. Abdominal Pseudohernia and Urinary Retention Due to Spinal Nerve Root Compression From …

How ‘Data Reviewed’ Works When Coding E/M

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. …

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