Mistake #13 — Ignoring Urgent Care Coding

There is nothing more frightful than ignorance in action.
— Goethe

Here’s why urgent care coding is so important: If you perform services, you should get paid for them. But if your urgent care doesn’t code for it, you will not get paid. Coding is the lifeblood of your new urgent care center. Ignore coding and you will hemorrhage potential revenue from your urgent care center.

There are scores of significant coding issues with which few physicians are fully familiar. Many of these issues are unique to an urgent care setting. Every day Practice Velocity fields questions about coding from coding experts.

Unique coding issues to your urgent care include:

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  1. When can you append an evaluation and management (E&M) code to a procedure?
  2. What modifiers must be added to an E&M code in order to assure payment?
  3. How can you successfully appeal when a payer consistently denies payment for the E&M code?
  4. What is the definition of an established versus a new patient in urgent care? How and when does it differ from a primary care practice? With what payers and in what circumstances do the definitions differ?
  5. When can you code for an intermediate laceration repair even if you have not performed a layered repair?
  6. How do you code for multiple procedures performed on the same visit?
  7. When can you get credit for a complete history even though a complete history was not performed?
  8. What is the difference between the CMS definition of body areas and organ systems for E&M coding?

I am a certified professional coder and write a monthly column in the Journal of Urgent Care Medicine (JUCM). Every month you can read more information about coding issues that are specific to urgent care. I encourage urgent care physicians to go to the JUCM website and sign up for a free subscription.

You can spend years studying coding, or you can work with an expert in urgent care coding. There are software and services that can help you with:

  • Automated E&M coding
  • Audit trail for each E&M code
  • Use 1997 guidelines and/or 1995 guidelines for E&M coding
  • Checkbox CLIA-waved test CPT coding
  • Automated ICD-9 coding
  • Automated modifiers related to global periods
  • Automatic code import into Practice Velocity Management billing software