Your team takes good care of patients, gets lots of clients, and people say great things about you online. But, you also need to make enough money. If your clinic is struggling with making money, it might be because of your billing.
To fix this, you should understand how urgent care billing works. Learn how to make your billing better and earn more money.
Now, let’s talk about the 2023 CPT codes for urgent care.
How does the billing at urgent care centers work?
Urgent care centers are becoming more popular, and they are expected to be worth $26 billion by 2023. To do well in this market, it’s important to understand how billing works and how to make the most money.
The billing process at urgent care starts when you arrive. They should have clear billing rules from the beginning.
You usually don’t have to sign up in advance at urgent care. But when you get there, the receptionist will ask for some basic information. They write down your name, address, birth date, and why you came. They also ask about your insurance, your primary doctor, and your policy number.
This information is put into electronic health records (EHR). These records help everyone, including the staff and doctors, keep track of your information and make billing easier.
CPT Urgent Care Codes
Urgent care places are growing fast. In just two years, they went from 6,946 centers in 2016 to 8,285 in 2018. This means doctors need to stay updated on how to bill and code for their services. Practices that choose to have medical billing partner, are generating more revenue out of their healthcare practices.
There are two main ways to bill and code services in urgent care.
First, let’s talk about S9088. This code allows doctors to bill for diagnosing and treating medical problems in an urgent care facility. Remember to also use the right evaluation and management (E/M) code with S9088.
In a case study, Using this code can help urgent care providers get more money to cover their costs.
Now, onto S9083. This code figures out how much to charge for the services given, no matter what treatment the patient gets. Some managed care organizations in Arizona and Florida use S9083 for billing.
Generally, it’s better to avoid S9083. That’s because it uses a fixed fee, and it doesn’t matter if the case is minor or serious, you get paid the same. In most urgent care situations, you can use S9088 or S9083.
But remember, Medicare is different. They have their own codes based on payment rates, medical rules, and where you are.
Guidelines for Urgent Care
When a patient’s visit is done, the person who writes down medical staff writes about what the patient has and what was done to help them. They use special medical codes, like ICD-10 codes for diagnosis and CPT codes for the care given.
CPT Codes and Their Types
There are three types of CPT codes.
Category 1 CPT Codes
Most people use these codes. They are for things like taking care of diseases, doing surgery, using X-rays, studying body parts, doing lab tests, and giving anesthesia and medicine.
Category 2 Codes
These codes are like extra information codes to help with quality control, but you don’t have to use them if you don’t want to. They don’t replace Category 1 codes.
Category 3 Codes
These codes are for brand-new medical things. They need approval from the FDA before they can be used.
Regular CPT Codes for Urgent Care
In urgent care, the most common codes are for evaluation and management (E/M). Here are some of them:
99214
This code is for when a patient who has been there before gets checked and taken care of in a clinic or similar place. The patient needs at least two of these three things: a thorough checkup, a moderate medical decision, and a detailed medical history.
99213
This code is for patients who need care and have similar issues as in 99214, but it’s simpler. It’s used a lot because it’s easier to get paid for, even though the payment is less.
99204
This code is for new patients at immediate care Algonquin. To use this code, the patient’s history, examination, and medical decisions must be thorough and a bit complicated. The payment is good, but it’s not easy to qualify for.
Most of the time, urgent care uses CPT codes like 99202-99205 and 99211-99215, according to the CPT assistant.
Urgent Care CPT Code Updates in 2023
Every year, there are changes to the codes used by urgent care providers. If you don’t follow these changes, it could affect your claims. Let’s look at the latest updates for 2023.
Exams and History:
These are not used in the E/M service.
However, you need to do them to report CPT codes 99202-99215.
We choose E/M codes based on:
a. The medical decision-making level.
b. The time spent with the patient on the day of the visit.
Face-to-Face Time:
Instead of the average face-to-face time, we now consider the total time spent with the patient for codes 99202-99215.
Medical Decision-Making:
For codes 99202-99215, medical decision-making includes:
a. Handling challenges in terms of quantity and complexity.
b. The depth or breadth of the analysis done.
You must meet two criteria to choose an E/M service level.
COVID-19 Vaccination:
Changes have been made to urgent care billing codes.
New codes are assigned for:
a. Injections into the muscles or under the skin.
b. Managing complications from vaccinations.
Additional Information
New modifiers are used to report these activities:
-
Right-hand side
-
L – left side
-
Only for participants in the Vaccines for Children (VFC) program.
Also, there are revisions to the HCPCS Level II code set.
In 2023, the E/M changes are crucial. Remember, the CPT code for an urgent care visit can greatly impact your practice. Seek assistance to reach your full potential.
