Mastering the Essentials: Coding for Urgent Care Practices

“The US healthcare system loses up to $935 million a week because of medical billing errors.”-Gitnux

With increasing population and a declining rate of healthy lifestyle choices, a greater number of people are getting inflicted by various diseases. On the remedial side, Urgent Care centers are taking the center-stage, and both patients and providers are happy with this extremely convenient, and immensely popular, modern day healthcare service.

During the past few years, private insurer’s claim percentage for Urgent Care has increased substantially. Unfortunately, a lot of Urgent Care facilities are losing money in payment collection from payers due to billing and coding errors. In this article, we are going to give you an overview of Urgent Care coding guidelines for 2023, and beyond.

Urgent Care Coding Guidelines 2023

Urgent Care billing is almost similar to Primary Care as both treat similar conditions. Urgent Care has specific CPT’s that are distinguished by codes initiating with “S”. The two codes that are applied to all Urgent Care services (excluding Medicare) are S9083 and S9088.

Frequently Used Urgent Care Codes

Most of the CPT codes used for Urgent Care are E/M codes and some of the frequently used Urgent Care CPT codes are:

  • Level 4 E/M (99204) is used for a new patient visit based on the level of care provided.
  • Level 3 to Level 4 E/M (99213 and 99214) are used for established patients based on the level of care provided.

Some Recent Changes in Urgent Care CPT Codes

Prior to report CPT codes 99202/99215, providers must complete accurate patient history and examination. When it comes to using E&M codes, the following criteria should be met:

  • Medical Decision Making (MDM) level
  • Total time spent for the treatment session during the day of encounter
  • The criteria for CPT codes 99202/99215 have been updated, shifting from assessing face-to-face time to considering the total time expended on the day of the encounter.

Thoughts on Meeting Coding Challenges

The medical billing industry is a highly dynamic area, with regular and frequent changes in billing protocols and coding guidelines. Medical coding per se is a highly specialized discipline, requiring high levels of accuracy and precision. It’s no wonder then that certified coders are so much in demand everywhere.

In a practical scenario, finding and employing competent coders can be a challenging proposition – both financially and logistically. This is why a growing number of healthcare providers, especially Urgent Care facilities, are outsourcing their billing & coding to specialized RCM companies. This is allowing them to gain instant access to overseas coders who can get the job done but at a remarkably reduced cost. As prices continue to soar across the US, strategic outsourcing of coding tasks might just be the most economical option available to healthcare providers currently.