Urgent care coding - the process of opening

[judyt]

Hi, my provider is in the process of opening an urgent care center. I would like information on the proper coding for this type of facility. I have been told to use codes (99201-99205) for all visits, even if the patient has been seen in the facility previously. Somehow this information does not seem correct. Any information provided would be greatly appreciated, also any literature I can obtain or of known workshop/seminar. Thanks.

 

[maisonw]

I work for an urgent care and it depends how your facility is set up. Ours is hospital based, which means we charge for supplies, APC's, and facility charges using the new UC codes that were provided as of January 2007 by Medicare. We also charge a professional fee using the E/M levels you described.

 

[donsqueen]

You need to look at the first page of the E&M coding guidelines about the 3 year rule. If the patient has been seen within 3 years by any physician in your practice in the same specialty, then an est pt code would be correct. If the provider documents the problem is new to them or the pt is new to them, then the complexity of the visit may be increased depending on the rest of the documentation.