Wiki How to properly use urgent care codes S9083 and S9088

[belardor]

How do you properly use urgent care codes S9083 and S9088?

Hello,

How can I properly use S9083 and S9088? My understanding of these two urgent care codes is that, if no other procedures are done within that visit, then you will use only the
S9083. But, if the same patient has other procedures in addition to the office visit, such as pathology and laboratory/microbiology tests then the S9088 code would be used instead, as this indicates to the payer that other procedures were done and the urgent care facility would be reimbursed at a higher level due to the additional time and effort that went into the visit.
Any help with this would be greatly appreciated.

 

[Mriyamblessie@gmail.com]

When to use S9083

Use S9083 when the payer wants a flat / case rate for urgent care.

Use S9083 if:

Payer policy says “bill S9083 for urgent care visits”

Contract is case-rate based

E/M codes are not required

How to bill:

S9083 alone

Plus procedures (X-ray, labs, injections) if allowed

Do NOT bill E/M

Do NOT bill S9088


When to use S9088

Use S9088 when the payer wants regular E/M coding, but also wants to identify the visit as urgent care.

Use S9088 if:

You are billing 99202–99205 / 99212–99215

Payer allows or requires an urgent care indicator

Contract is fee-for-service

How to bill:

E/M code

+ S9088

S9088 may pay $0 but supports processing

Example:

Payer wants E/M but tracks urgent care visits
Bill: 99203 + S9088

Never do this

S9083 + S9088 together

Why?

S9083 already represents the full urgent care visit

S9088 becomes duplicate / unbundled