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Thread: Urgent Care EM

  1. #1
    Join Date
    Apr 2007

    Unhappy Urgent Care EM

    AAPC: Back to School
    I'm trying to find current documentation that states whether or not a an E/M is needed on EVERY encounter in Urgent care? I am conflicted w/ this because the documentation isn't backing up the -25 rule. Our doctors aren't doing complete work up then... managing a separately identifiable problem. Please help!! If you'd need an example:

    John Smith comes into UC for broken leg. Doctor sends patient to x-ray, applies strapping and gives a pain med. ROS/PE are pertaining to the leg.

    Would a E/M be given with a -25 modifier, because of the office setting?

    Documentation would help a great deal, can you please point me in the direction I am needing.

  2. #2
    Join Date
    Apr 2007


    I'm curious what you are billing for your broken leg. Generally when we see that type of patient we don't do the fracture care, we send them on to ortho who does the fracture care, so all we are left with is the E/M and supplies or what not.

    In a broader answer to your question, no an E/M is never required in any setting.

    Most times in an urgent care or emergency setting they do have to do a lot of E/M work because these are new patients so many times it is appropriate to have an E/M related to the same issue as the procedure. They don't have to be about different issues, it just has to be more than the mini E/M that is included with all procedures and support the use of the 25.

    So if a 70 yr old man with DM comes in with a laceration to the foot you would most likely see a lot more E/M work done than say a 17 yr old that has no other issues. Is it appropriate to just have the lac repair, yes.

    There is no clear cut answer for your question, it is going to be case by case. There are times when an E/M is justified but the documentation doesn't support it. Others when the documentation supports it but the medical necessity is not there.

    Laura, CPC, CPMA, CEMC

  3. #3
    Join Date
    Apr 2007


    thank you so much for your response... It helps to have the support.

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