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PennyG

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Still looking for some help regarding urgent care clinics located within the hospital. Our hospital is establishing an urgent care clinic within the emergency department. Would a facility fee be charged, in addition to an outpatient evaluation and management code?

Are there any special codes for urgent care clinics?
 
Penny:

There are no special codes for urgent care. Typically it is coded as any other outpatient service (99201-99215) as either a new or established patient.

There should be a facility fee, since the physical location is in the hospital, but you may want to investigate how this arrangement is occurring. Is the space rented from the hospital or are the physicians and practitioners staffing the urgent care area employees of the hospital? Does the hospital reserve the right to code and capture the facility fee?

Try and get in touch with the chargemaster manager at the hospital. He/she should be working on this, so opening a dialogue will only help both of you to deploy this change successfully.

In addition, I would be cautious about the hospital facility charge coming from the 99281-99285 series. Although I personally know of facilities that charge this for urgent care visits, I do not believe that charge is supported either by medical necessity, nor designation of the area as "urgent care."

Just some items to think about.

Good luck.
 
Urgent care

Kevin,

Thank you for the response to my thread. This urgent care clinic will be a separate part of the hospitals emergency department. Owned by the hospital. The Physicians and non physician practitioners will not be employed by the hospital. I realize the place of service will be 20 and also realize CPT codes 99281-99285 will not be appropriate to charge.

I am thinking the facility charge would be a UB-04 billing issue. Can you verify that for me?
 
PennyG said:
Kevin,

Thank you for the response to my thread. This urgent care clinic will be a separate part of the hospitals emergency department. Owned by the hospital. The Physicians and non physician practitioners will not be employed by the hospital. I realize the place of service will be 20 and also realize CPT codes 99281-99285 will not be appropriate to charge.

I am thinking the facility charge would be a UB-04 billing issue. Can you verify that for me?
Click to expand...

Depends on what your state's laws are regarding the licensing of urgent care facilities; we have some that use the CMS-1500, but they're not considered quite the same thing as those that bill facility charges, which are really like mini-emergency centers. If you're billing on the physician side, you can use 99051 and/or S9088 during the evening/weekend hours to indicate that services were provided in an urgent care setting after regular business hours. Some payors cover it, but not all of them. Hope that helps! ;)
 
Good info from all of you here....

I have been hired to do set up, billing/coding for a General Surgery group. my understanding is that most of the surgery's will take place at the hospital, kind of like their own surgery center. I have no clue how to set up a group as far as NPI's PTAN's and Tax ID's and I'm confused on how my HCFA 1500 should look as a group. I have only billed for professional services for individual providers....Can someone educate me on this please !!!!

Desperate need of help !
 
General Surgery Center

Good info from all of you here....

I have been hired to do set up, billing/coding for a General Surgery group. my understanding is that most of the surgery's will take place at the hospital, kind of like their own surgery center. I have no clue how to set up a group as far as NPI's PTAN's and Tax ID's and I'm confused on how my HCFA 1500 should look as a group. I have only billed for professional services for individual providers....Can someone educate me on this please !!!!

Desperate need of help !
 
bill2doc said:
Good info from all of you here....

I have been hired to do set up, billing/coding for a General Surgery group. my understanding is that most of the surgery's will take place at the hospital, kind of like their own surgery center. I have no clue how to set up a group as far as NPI's PTAN's and Tax ID's and I'm confused on how my HCFA 1500 should look as a group. I have only billed for professional services for individual providers....Can someone educate me on this please !!!!

Desperate need of help !
Click to expand...

Here's a start:

https://www.cms.gov/NationalProvIdentStand/01_Overview.asp

You'll register as a group. It's going to be just like individual doctors, except you'll have 2 NPI's for each: They'll have a group NPI that goes in 33A, and an individual NPI that goes in 24J. The billing name will be the group name (Box 33), and you'll put the individual doctor's name in Box 31. The service facility (Box 32) will be your place of service, and you'll use the POS code for outpatient hospital (22) in Box(es) 24B. All of your doctors will use the same Tax ID in box 25, and you register that with the IRS. Let me know if you need anything else. ;)
 
Thank you so much Brandi. I am going to pull a 1500 out and write this in a templet. The doc said that she would be doing general surgery in the ER, Trauma in the Trauma unit or Trauma Bay. Confused if this is all inpatient 21 or if there is a Trauma/ER POS code for when the services are done in the hospital. Thank you very much again. Very helpful!
 
bill2doc said:
Thank you so much Brandi. I am going to pull a 1500 out and write this in a templet. The doc said that she would be doing general surgery in the ER, Trauma in the Trauma unit or Trauma Bay. Confused if this is all inpatient 21 or if there is a Trauma/ER POS code for when the services are done in the hospital. Thank you very much again. Very helpful!
Click to expand...

I think there's one for the ER, but I don't know off of the top of my head. There's a list of all of the place of service codes in the front of your CPT book (like, in the first page or two), if you have the AMA's Professional edition. That should get you pointed in the right direction. If you don't have it, let me know, and I'll check mine tomorrow to see what they say. Good luck! :)
 
Brandi,

We have an Urgent Care center that shares the same TIN with our internal medicine doctors. The internists sees patient in the urgent care and in their office. After a patient is seen the Urgent Care they get referred to an internist, can the internist bill for a new patient visit if he/she has seen the patient in Urgent Care? My understanging is that they can't because the UC and internal medicine doctors are considered one group.
 
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