Wiki E&M in the Urgent Care

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gchmelewski

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A lot of my visits are new problems with a work up. Then very often sent onto the ER for the differential dx's indicated in the MR.

#1 With this being said one example a pt comes in with abdominal pain, lets say some labs were done and and exray. Mr says sends pt to er for further evaluation. then shows differential dx of poss appy, etopic pregnancy.

Can I used those differential dx in the urgent care in my mdm or only the abdominal pain??? How would you guys score this for a new pt and for an est pt.? (any links to support would be helpful)

#2 pt comes in with chest pain, sent to the Er. MR states chest pain differential dx of MI. exray done. How would you code this for new pt and for est pt.



Thanks
Ginger, CPC, COC
 
The rules for coding E&M in urgent care are the same as for coding in any other setting and you would assess the history, exam and MDM from the documentation using the same guidelines as for E&M in an office or other facility - there aren't any coding rules that I'm aware of that make exceptions for the situation you're describing.

That said, however, in cases where your providers are sending your patients to the ER or to another facility for treatment, it is certainly reasonable to take into account the fact that you are essentially telling the patient that your facility is not equipped to handle their problem and that they need to seek treatment elsewhere. The patient is likely going to be facing a substantial charge from the hospital ER and it will certainly create customer dissatisfaction and likely generate a complaint if they receive a very expensive bill from your providers as well. Changing how you assess the level of MDM to account for the fact that the patient is being sent away is perhaps one way to go about this, but I'm not sure it's the best solution. In the group where I used to work, the hospital was under the same ownership as the urgent care center, so urgent care visits that ended in a referrals to the ER were made no-charge visits since the work that was done was going to be used by the ER physicians to continue to evaluate that patient and would go toward the ER charges. If your care center is independent though, you are within your rights to expect some compensation for the provider time and services rendered. I would recommend you discuss this with the practice managers, owners and physicians and come up with a method that is fair both to the providers and the patients, and compliant with coding guidelines, and develop a policy as to how and whether you are going to bill these types of visits so you are handling all of these situations in a consistent way.
 
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