Questions for Dr. Stern
About Your Urgent Care Center
36. We have recently opened our first urgent care and there has been some disagreement on charting. Is there a location to find documentation on the required charting for an urgent care? I know the urgent care uses the same E & M codes as a family practice. Does the same criteria apply to an urgent care as in a family practice i.e. family history, past medical history, social history, etc? We have a provider working at the urgent care that comes from an emergency room environment and he is insisting those items aren’t required to substantiate an evaluation and management level of service. Is that correct?
Thank you for contacting UCAOA. We are excited to see our many members thrive in serving their communities all over the USA.
To answer your question, the same criteria (for e/m coding: 99201 - 99205) apply for an urgent care center and for a family practice. Of course, these criteria are extremely complex and very few providers have a good handle on them. Isn’t it just like the government to set up rules that are so complex that no reasonable person can follow them; and then charge any doctor with fraud who does not follow their rules exactly?
Your provider’s confusion may arise from the ED background of your provider. The criteria for ED e/m codes (99281 99285) do not correlate with the outpatient e/m codes (99201-99215).
