AAPC - Back to school
Page 2 of 2 FirstFirst 12
Results 11 to 17 of 17

Thread: new patient or established?

  1. #11
    Join Date
    Apr 2007
    Baton Rouge Local Chapter

    Default Urgent care codes

    AAPC: Back to School
    Quote Originally Posted by Bsivera View Post
    Are Urgent Care Centers required to pay additional fees just for operating during a 24 hour basis? I have seen some Urgent Care Centers charge a couple hundred dollars under HCPCS code S9088--which is for an urgent care center (in addition to the service code byt the physician). Why do you typically bill with this additional code and do you usually get paid for it?
    Some insurance carriers pay additionally for the S9088. It depends on how the contracts are set up with the carrier. You don't have to be open 24/7 to charge this code. You just have to be considered and contracted as an Urgent Care Facility. Most of our clinics are open extended hours but close by 9 -11 pm and are open 7 days a week.

    Depending on the state and insurance the reimbursement can be between $8 - $80

    There are additional fees associated with operating an Urgent Care Facility. Appointments are not scheduled, there are extened hours and most are open 7 days a week. Unscheduled appointments mean that patient flow in the urgent care center is quite unpredictable, so the urgent care center will sometimes be open for hours, serving no patients and generating no income. Meanwhile, the expenses of salaries, benefits, heating/cooling, etc. will continue to accrue. Staff in primary care physician offices generally work bankers hours. Staff in urgent care centers work weekends, holidays and evenings. Thus, hourly compensation for urgent care staff will reflect this differential, resulting in higher wage costs for the same staffing.
    Last edited by S Avara CPC; 05-12-2009 at 09:41 PM. Reason: Additional info

  2. #12

    Default Urgent Care and Pediatric

    Quick question ... does this hold true if patient went to our Urgent Care (new patient) and then 2 weeks later saw our Pediatric physician? Is the patient considered an established pt? Is Pediatric considered Family Practice/Internal Med ?

    Thank you

  3. #13
    Join Date
    Apr 2007
    Boston, MA


    A patient is established once the provider or another member of the group/specialty has seen the patient. A patient is also established if the provider has seen the patient before while working for a different group - basically if the provider who sees the patient today has seen the patient before (face-to-face) today's visit will be established. It doesn't matter where the patient was seen before - urgent care, office, inpatient....
    Only if more than 3 years have passed since the prior encounter this may be a new patient (again).

  4. #14
    Join Date
    Apr 2007
    Boston, MA


    How are your involved providers credentialed? If one is internal med and the other is pedi they are different specialties...

  5. #15


    Our urgent care doc's are credentialed as Family Practice and our Peds doc as Pediatric. So I guess the patient would be established.... I thought Pediatrics would be the same as Internal Med/Family Practice.

  6. #16
    Join Date
    Apr 2007



    If the patient was seen by Family Med/Internal Med in Urgent Care then seen in Peds later, they would be new in Peds if they haven't been seen by that Pediatrician, or one in that group (same FEDID), within the last 3 years.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  7. #17


    Thank you Pam!

Page 2 of 2 FirstFirst 12

Similar Threads

  1. Replies: 7
    Last Post: 05-19-2016, 08:23 PM
  2. new patient vs established patient guidelines in a SNF-please help
    By CTRAVIS in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-27-2014, 08:46 AM
  3. Urgent care new patient vs established patient
    By ewheeler in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-12-2012, 11:53 AM
  4. Billing a new patient vs established patient
    By kcaskey03 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 11-15-2011, 01:00 PM
  5. Replies: 9
    Last Post: 04-27-2009, 02:27 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.