ICD-9 Coding in the Urgent Care Center

Question: Recently, we received the following question about ICD-9 (diagnosis) coding.

A nursing supervisor through our parent hospital is questioning the ability of an MA to legally write in ICD-9 codes matching physician diagnoses. It is my understanding that MAs get this training in school and as long as the physician is assigning the diagnosis and E&M code, the MA (certified MAs) can write in an ICD-9 code which directly matches. It has been this way in all offices I have worked in. If you have any like or something in writing supporting this, please let me know.

Answer: The physician is ultimately responsible for all codes billed out for all professional services billed under the physician's provider number. There are many ways, however, for the facility to do this.

1. Have staff assign the codes, and require the physician to initial the final codes.
2. Force physician to assign all codes.
3. Have staff assign the codes (after physician writes down the diagnosis), but have physician do audits of randomly selected charts on a regular basis to make sure that, for compliance reasons, the physician agrees with the codes being chosen.
4. Use checkboxes on a form so the physician can assign the majority of codes. If this is combined with a commercially available "cheat sheet" of most common codes, over 90% of the ICD-9 codes can be readily assigned by the physician, without slowing down the process.
5. There are probably other compliant methods for ICD coding in the urgent care center.

Urgent Care Mini-Conference a Big Success

We just returned from the Fall Mini-Conference of the Urgent Care Association of America in Phoenix, AZ. The Association was expecting an attendance of fifty, but the urgent care community responded enthusiastically, and 125 urgent care professionals showed up at the conference. The enthusiasm of the attendees was exceptional, and the most common theme of goodbye was, "See you in Daytona," i.e., the 2007 National Convention of UCAOA (May 9-12, 2007).

I had the privelege of sharing three talks, 1) MCO Negotiation for Startup Urgent Care Centers, 2) Problem-Based Coding, and 3) Specialized Codes in Urgent Care (S9083, S9088, 99050, 99051 and 99058). All talks from the mini-conference will be available on CD through the UCAOA in a few weeks.

It has been a joy to watch UCAOA develop its vision to be a democratic, representative, professional organization of the highest caliber. Congratulations are due to Lou Ellen Horwitz (Executive Director, UCAOA) for the excellent quality she delivered at her first UCAOA conference.

See you in Daytona.