KPI Driven Urgent Care Coding Services for a Transparent Flow

Like any other urgent care practice, you must have witnessed tough changes with significant urgent care coding and clinical documentation updates to date. On Sep 1 2020, the AMA released the 2021 CPT code set that contained major overhaul which was the first in more than 25 years.

✔️ Among the major changes, the eliminating history and physical exam as elements for selection of codes were the ones which need special mention. AMA clearly explained that the new changes in E/M coding and guidelines for documentation will be making the process all the simpler.
✔️ Services in an urgent care are coded based on the service level extended by the physicians to the patient similar to a physician office visit (CPT 99201-99215). The services are extended according to Level 1/Triage Care, Level 2/Intermediate Care and Level 3/Complex care.
✔️ Understanding the difference between an emergency setting and urgent care determines the success of the codes. To simplify your process of urgent care coding is critical to address reimbursement in the long run. At present, reducing your overall operational costs is a major area of concern and needs immediate attention.

Can we bill CPT 99281-99285 in urgent care?

Code 99281-99285 symbolizes emergency care services which are rendered in hospitals and are reimbursed according to POS 23 (Emergency Room). It cannot be used with POS 20 (Urgent Care facility). Understanding the difference is the key to success in urgent care coding.

Why choose Sunknowledge for urgent care coding?

We have been an exceptional service provider of quality urgent care coding services to some of the largest providers. Our team defines your claims with an excellent combination of using the correct diagnosis and procedure codes. At just $7 per hour, leverage on the competitive advantage we have on offer with our urgent care coding services.

When should you bill CPT S9088?

CPT S9088 can be billed for all unscheduled or any walk in visits to urgent care centers. It should be remembered that the CPT should not be billed alone as it is add on code. It should never be billed alone and has to be billed with other services extended on the same day unless regulations restrict it. CPT S9088 is not a valid code for Medicare and Medicaid insurance.

In urgent care centers can we bill CPT 99211?

If the patient comes back for a PPD test, BP check up, refills and B12 reading, then we can bill CPT 99211. It may not require the active intervention of presence of a physician.