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Thread: Coding for 99204

  1. #1
    Join Date
    Apr 2007

    Default Coding for 99204

    AAPC: Back to School
    Is it normal for an Urgent care provider to code 99204's for most new pt visits? The criteria is met but I am asking because for this code, the HX and PE are comprehensive , would it be justify to bill 50% 99204's?
    I Would like to hear your input. Aslo, where can I find National EM ditribution by specialty, any links? where do I look?

    Thanks for your input!

  2. #2


    I would say that billing 50% 99204s in an Urgent Care Center would cause a red flag. That is not to say that some of them are not legitimate but I would audit them carefully to make sure. I know that Decision Health used to have a book and an accompanying CD that had the E/M distributions but you may be able to find them online.

  3. #3


    The Urgent Care Association of America would be a good start.

    To order the 2010 Urgent Care Benchmarking Study visit www.ucaoa.org or call (877) 698-2262.

    When I coded UCC visits, the company saw level 4 visits, new and established patients, soar when prescription drug management for moderate MDM risk of a new problem was documented. We just didn't see the medical necessity for many of these encounters. Providers were angry when they were penalized for documentation deficiencies (less bonus money) on 99204 visits that require more documentation than a level 5 ED visit. The compliance department instituted guidelines for low MDM for the single complaint ear pain, simple sprain and lac repair visits with a prescription. The providers were happy, the coders were thankful for a written policy but the president of the billing company was not amused when 99204/99214 visits decreased.

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