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new patient or established?

  1. #11
    Default Urgent care codes
    Medical Coding Books
    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. 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
    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
    How are your involved providers credentialed? If one is internal med and the other is pedi they are different specialties...

  5. Default
    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

    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, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  7. Default
    Thank you Pam!

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