Wiki E/M urgent care

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Hya726

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I am completely new to E/M coding and I’m really struggling. If anyone is familiar with an urgent care billing and can provide insight that would be great.

Could any help with minor illness versus Acute illness/injury versus acute illness with systemic symptoms? If a patient comes in with congestion, body aches, and fever what would that fall under?

Also, can a provider bill an E/M and 10630? Patient came into urgent care with a 2nd degree burn from grease. Provider billed E/M 99214 and 10630. During the visit provider dressed the burn and gave an injection of pain medication.
 
I cannot stress enough how helpful and valuable the AMA 2021 outpatient guidelines are. They define the items listed in the table.
You might have 2 patients with the same dx of congestion, body aches and fever.
Patient A is taking some OTC cold meds, fever of 99.2 and really just feels a bit under the weather.
Patient B has body aches are so bad they are barely able to get out of bed, and fever is 104.6 with delirium. They also have HTN and DM and are unable to take many OTC cold meds. And let's throw in renal disease with a kidney transplant 2 months ago.
You might consider A an acute uncomplicated illness (low level 3 for problem), but B could be high.

Regarding 10630, you must have a typo - that code does not exist. If the E/M and a procedure are NCCI edits, then you would only bill the E/M if it meets the guidelines for modifier -25 significant and separately identifiable.
 
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