Wiki Urgent care & Ed same day

[bbernardin]

Patient seen in urgent care then sent to ED. Is urgent care visit billable with 25 modifier?

 

[BrittanyDee]

was the patient sent from urgent care to the ED?

 

[thomas7331]

Patient seen in urgent care then sent to ED. Is urgent care visit billable with 25 modifier?

If the urgent care center is not affiliated with the hospital where the patient was sent, the visit can be billed (no modifier is necessary), assuming the services documented do support a charge for that visit. But if it's part of the same organization as the hospital, then your hospital management should give you guidance on how to handle this situation.

Either way, though, many urgent care centers won't charge in this situation since the reason the patient is being sent to the ED is because the urgent care center does not have the ability to adequately diagnose and treat the presenting problem. The visit is usually considered a courtesy since the patient will still require a full work-up at the hospital.