Urgent care centers are experiencing explosive growth as the healthcare industry evolves. The faster treatment option within these centers has resulted in massive popularity across the country. In fact, in just nine years, the payment percentage from the private insurers for urgent care services has increased considerably. However, even though it is a lucrative industry, there are many urgent care centers and facilities that are losing revenue due to errors in urgent care billing and coding.
If you are struggling with the coding guidelines in your urgent care facility, then you are at the right place to understand the tidbits of coding in urgent care.
Most Common Codes in Urgent Care Billing
The CPT codes in urgent care billing fall between the 99202-99215 range. Codes from 99202-99205 denote the new patient or other outpatient services. Codes ranged between 99211-99215 identify established patient office or other outpatient services.
- 99202: 15-29 minutes of office or other outpatient services for the evaluation and management of new patient. Consists of three major components- problem focused history, expanded problem focused examination and straightforward medical decision making.
- 99203: 30-44 minutes of office or other outpatient services, consists of same components as 99202.
- 99204: 45-59 minutes of office or other outpatient services, consists of expanded patient history, examination and medical decision making of moderate complexity.
- 99205: 60-74 minutes of office or other outpatient visits; medical decision making is high in complexity.
- 99212: Established office patient visit of 10-19 minutes. Consists of medically appropriate history and straightforward medical decision.
- 99213: Established office patient visit, 20-29 minutes of office or other outpatient services for the evaluation and management of an established patient. The medical decision making in this case is of moderate complexity.
- 99214: Established office patient visits for 30-39 minutes with a medical decision making of moderate complexity.
- 99215: Established office patient visit for 40-54 minutes with a medical decision making of higher complexity.
Billing for primary care and urgent care is almost identical as they provide nearly similar services. Yet there are some services in urgent care that are distinguished by S codes.
There are two S code groups that pertain to all urgent care services except Medicare for billing purposes. The groups are as follows-
S9083: The code for urgent care billing allows you to charge a single service fee regardless of the patient’s treatment plan. This billing code can be required by some Managed Care Organizations (MCO) for hospital bills.
S9088: Services provided in an urgent care facility are usually denoted by this code. This code allows you to bill for medical diagnosis and treatment while recognizing the punitive services provided in urgent care centers. You must use this code in conjunction with evaluation and management services to ensure accurate billing. Furthermore, this allows you to be reimbursed for a portion of service rendered immediately.
Wrapping Up
Urgent care billing and coding is a complex task and handling these procedures internally is not a good idea from an economic or strategic viewpoint. Also, you might face difficulties in maintaining compliance with the changing rules of coding for urgent care. All these can be quickly dealt with by partnering with an outsourced revenue cycle management organization like Sunknowledge Services Inc. A dedicated team of medical billers and coders can easily help you grow your practice. Reduced risks of claim denials are achieved through rapid, real-time, accurate and timely claim submission- you can have a streamlined process with a genuine outsourced partner. They will closely monitor your revenue cycle performance and navigate your ROI in a positive direction. Complying with the dynamic landscape of healthcare is a tedious process. Yet you can focus on your core competencies with a reliable RCM partner.
Sunknowledge Services Inc. – an ISO 27001:2022 certified, American-owned & operated company, headquartered in New York City – is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain.
