Questions for Dr. Stern
About Your Urgent Care Center
154. We are an urgent care center we have quite a few primary care docs send the patients for x-rays. they have the script and they don't want to see by my UCC doctor. so what we do is Ala-Carte services for all the primary care docs for their labs/ xrays. have few questions:
1) should I collect the Urgent Care copay (or) radilogy imaging services copay (which normally be $0)
2) can i bill to the global fee contract insurances with S9088 and S9083
3) can I use the same diagnosis code that the patient brings along with the script from their primary care doc for billing purposes.
4)is the UC doctor responsible for reading the xray (note: the doctor is not seen the patient its just a ala-carte service only).
In answer to your questions:
- Every payor is different, so you will have to check with each payor. Since you are contracted as an urgent care, payors may apply the urgent care copay, but you may be able to get them to waive this when only radiological services are performed. Contact each payor to understand their policy.
- S9088: this would not be appropriate, as you are not actually rendering urgent care services
- S9083: some payors may accept this, but it is not really the intended use of the code. However, their software may be set up to allow only this code from your practice, so this may be the only way to bill for services to the payor.
- Denials: some payors may refuse to pay for radiological services only, as they will interpret the contract as offering reimbursement for urgent care services only.
- ICD-9: Yes, the diagnosis on the prescription is appropriate to use. You will want to be sure that the payor will cover the specific radiological service (i.e., reimburse for the CPT) when linked to that ICD-9 code.
- Professional fee: Usually the urgent care will send these films to an outside radiologist, who will provide a reading back to the ordering physician and bill the CPT with modifier -26 (professional component) to get reimbursed for the reading of the study. In this arrangement, you would code the CPT code with modifier –TC (technical component) to be reimbursed for the actual shooting of the film.
There are lots of possibilities, but with persistence, most payors will be reasonable in finding a way to reimburse you for this important service to their members.
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