Wiki Urgent care facilities

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martyzal

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What E/M codes do you use for an urgent care facility? Would it be the same as physician's office codes?
 
What do you mean by urgent care? Is the urgent care like an emergency room? Or like a physician's office?
 
Urgent care

It is not in the emergency room. It is a physicians office that sees patients a walkins not by appointment.
 
Yes that is correct, you would bill office visit codes, however, you need to use the place of service 20 instead of 11. Also, this was something I didn't know, you can bill 99050 for holidays, Saturdays and Sundays. Some insurances will reimburse this code. Happy holidays.. :)
 
Do not use place of service 20 unless you are freestanding urgent care only facility.

Also, many payers will not pay for 99050, in the case of Medicare you have to write it off. Many commercials will leave it as patient responsibility.

Laura, CPC, CEMC
 
Laura, you are correct... I am only speaking of freestanding urgent care facilities. Sorry I wasn't specific. Also, 99050 can be billed to any insurance, however it depends on the ins if this will be reimbursed. Commercial, and W/C does pay for this service. In my own experience, we did not bill patients for any balances out to patient for this code. We did write it off.
 
We are also a Free Standing Urgent Care/Emergency Room. We are contracted with Medicare as an Urgent Care facility, and they are denying our 99235 observation code. My thought was to go to the 99218-99220 catergory however, it does state that these are for HOSPITAL Observation services, and we bill out a POS of 20 for this payer. Any ideas on how we can bill and get paid for observation care??? :confused:
 
Are you an Urgent Care facility or an Emergency Room. That would make a difference of how you would code these type of visits. If you are contracted as an Urgent Care facility and located in a hospital, then you are not considered free standing, and should not be using a place of service 20. So it would all depend on where you are located?????
 
We are a Free Standing Emergency Room. Aetna and Medicare and Medicaid will not recognize us as and emergency room, so we are contracted with them as an Urgent Care facility, and for all other carriers (we are NOT contracted), we bill out as an ER. For the carriers that we bill out a POS 20, would it be wise just to use the prolonged services codes (99354 & 99355) instead of observation status?
 
Absolutely, you read my mind. Because you are contracted as an urgent care facility for those payers, you cannot bill hospital observation codes so you are forced to use the prolonged service codes. :(

Why do they not consider you an emergency room facility? Are you open 24 hours a day, 7 days a week and located in a hospital??? If not, then it is unfortunate that you cannot bill those codes.. good luck, hope that helps, even though you answered your own question...lol Happy Holidays :)
 
Thanks Kristen! I am still pretty new at this, and am sometimes unsure of myself! I am really finding these forums to be useful!
 
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