- May 15, 2023
- Posted by: Thomas Anderson
- Categories: Urgent Care, Urgent Care Billing
Navigating through the complexities of healthcare billing can often seem like an intimidating task, especially when it comes to understanding CPT codes. This article aims to shed light on the question: “What CPT codes are used for urgent care?”
What are CPT codes?
Current Procedural Terminology (CPT) codes are numbers assigned to every task and service a medical practitioner may provide to a patient. These include medical, surgical, and diagnostic services. Introduced by the American Medical Association (AMA), these codes are a critical part of the medical billing process.
Common CPT Codes in Urgent Care
Urgentcare centers, serving as a bridge between primary care physicians and hospital emergency rooms, utilize a variety of CPT codes. The top five most frequently billed CPT codes in Urgent Care, according to a 2022 study by the Urgent Care Association (UCA), include:
1. 99213 (Office/outpatient visit, est): This code, used in 36% of urgent care visits, signifies a moderately complex visit for an established patient.
2. 99214 (Office/outpatient visit, est): Accounting for 24% of the cases, this code is for a more complex visit for an established patient.
3. 99204 (Office/outpatient visit, new): This code, making up 17% of visits, is used for a moderately complex visit for a new patient.
4. 99203 (Office/outpatient visit, new): Used in 11% of cases, this code denotes a less complex visit for a new patient.
5. 99212 (Office/outpatient visit, est): This code is used for a less complex visit for an established patient and accounts for 8% of urgent care visits.
Procedure-specific CPT Codes in Urgent Care
Aside from the general visit codes, there are other procedure-specific CPT codes frequently used in urgent centers. For instance:
♦ 87804 (Influenza assay with optical immunoassay): This code is for a rapid flu test, which according to the Centers for Disease Control and Prevention (CDC), saw a 15% rise in usage in urgent care centers during the 2021-2022 flu season.
♦ 81003 (Urinalysis, automated, without microscopy): Used for automated urinalysis, this code is frequently used in urgent care, with a usage rate increase of 7% from 2020 to 2022.
The Significance of CPT Codes
Understanding CPT codes is essential for multiple reasons. For patients, it helps decipher the services they received, ensuring accurate billing. For healthcare providers, proper coding is crucial for fair reimbursement. Furthermore, health researchers and policymakers often use these codes to track, analyze, and make informed decisions about public health trends.
It is important to understand that while this article provides a glimpse into the complex world of CPT codes in urgent care, each patient encounter is unique and may require the use of abstruse or less used codes. Therefore, the appropriate use of CPT codes can vary based on the specifics of each case. For more comprehensive information, one can consider contacting a medical billing professional or consulting the AMA’s CPT code manual.