About Your Urgent Care Center

35. Dr. Stern,  I enjoyed reading your artile "how to Define a Type B ED" in a recent JUCM journal.  I have a question I would greatly appreciate an answer to.  I am the medical director of a number of hospital owned urgent care centers.  I recently discovered we use a large number of good quality, and expensive arm slings, as well as numerous ace wraps, wrist splints, etc.  I was told we have done this for years and have never charged for them.  Our billers and coders say these items are a part of the office visit and we cannot bill for them.  What do you say about this situation?  I appreciate any help you can provide.

Thanks for contacting us. It is always great to hear from other physicians in the urgent care community. Excellent E/M coding is the key coding issue in reaching financial success in most urgent care centers. However, capturing revenue from many other codes can, also, make a significant difference in the finances of an urgent care center. Many supplies are not included in the E/M, and can be coded, using HCPCS codes. Examples include:

• Velcro wrist splints (L3908)
• Arm slings.(A4565)
• Velcro short leg boot (L3260)
• Ankle air cast (L4350)

The good news is that you don’t have to take my word for it. The following refers specifically to CMS rules, as it is a direct quote from the highly respected Part B Answer Book (Supplies section – page 21201):

Splints, casts and other devices will be paid separately when provided in a physician’s office. First, you have to determine if the splint, cast or other device is an A code or an L code: typically a prosthetic or orthotic applied to the patient in the doctor’s office. Depending on which code you use, you will bill either your carrier or DMERC (see the list of codes in the Durable Medical Equipment section to see which payer to bill). (Note: If a doctor bills these as a supplier, the doctor must have a supplier number.)

A Codes used are A4565 (slings), A4570 (splint), A4572 (rib belt), A4580 (cast supplies) and A4590 (special casting materials, or equal). If you bill an A code, make sure that you provide sufficient information in Box 19 of the Form 1500. (However, bill the more specific L codes if you can.)
The confusion may come from the fact that some supplies are not billed in addition to other codes.

For example, dressings after laceration repair are included in the laceration code. Again, here is a quote from the same page of Part B Answer Book:

Surgical dressings aren’t paid separately when provided in a physician’s office or an ambulatory surgery center. If a physician, certified nurse midwife, physician assistant, nurse practitioner or clinical nurse specialist applies surgical dressings as part of a professional service that is billed to Medicare, the surgical dressings are considered incident to the professional services of the health care practitioner and are not separately payable.

I hope this clarifies the situation. Feel free to call or have your coders call me about this issue.
Note: Physicians Immediate Care operates nine urgent care centers in Illinois and Oklahoma. About 200 urgent care professionals toured our urgent care centers last year. If you are ever in the area, feel free to drop in for a part-day or full-day tour of our urgent care headquarters (one hour from Chicago O’Hare Airport).

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