Questions for Dr. Stern
About Your Urgent Care Center
26. We are a new urgent care clinic (6 months). I have read several articles on billing and coding practices for urgent care centers, including your column in The Journal of Urgent Care Medicine. My question is concerning the E & M codes; should urgent care clinics code according to new problem/established problem versus as new patient/ established patient? I have read that urgent care clinics should be billing 99201-99205 for new problems and 99211-99215 for a recurrent problem that has not resolved regardless of whether the patient has ever been seen in the clinic before. Is this accepted by CMS and other payers? I have combed their website and I cannot find any documentation that supports this billing practice. I have managed private practice for over twenty years but this is my first experience with urgent care. It is very apparent that urgent care is a unique animal! I want to be very sure I am providing the most accurate information to my providers.
New patient and established patient rule is the same for urgent care and other physician office visits. You can only alter this coding with a contractual agreement with a payor. CMS NEVER does this. Read more about this by clicking here. Feel free to call us at 888-357-4209 with any questions.
