Urgent care centers, how they bill for services, and how they organize medical records are important for their work. If things could be improved in any of these areas, it could cause big problems, like making it harder for the center to generate revenue. Imagine if an ambulance rushes to help someone in an emergency but writes down the wrong information. This mistake can lead to problems with billing, like not getting paid correctly, which is basically like doing important work for free. Even though people try hard to get these things right, mistakes with paperwork can still make it tough for urgent care centers to make enough money.

 

In 2023, a staggering 89 million patients were treated at urgent care clinics in the United States. This accounts for nearly a third of all visits to primary care doctors and approximately 15% of all visits to outpatient clinics. The sheer volume of patients underscores the critical need for accurate billing and meticulous medical record organization.

 

Now, let’s discuss the important rules that urgent care billing services must follow. Hospitals use the International Classification of Disease, 10th Revision, Procedure Coding Systems (ICD-10-PCS) to organize medical procedures. When using these codes, it’s important to follow the Health Insurance Portability and Accountability Act (HIPAA).

Medical Billing & Coding Guidelines 2024

 

The 2024 guidelines for medical billing and coding contain important information. Medical billing specialists, especially those in urgent care, must know these guidelines well. This helps them make sure they code medical services correctly. It’s important for urgent care because it helps patients get the right amount back, and healthcare providers only pay a little.

 

The Centers for Medicare and Medicaid Services (CMS) changed the Place of Service (POS) code for urgent care centers to 20. This change affects how urgent care centers code and bill.

 

There are also updates in Evaluation and Management (E/M) codes for urgent care visits. These codes show how much care a patient gets and ensure providers get paid the right amount.

 

To ensure claims are correct, CMS wants more people to submit claims electronically. This is important because it makes the process of submitting claims smoother.

Let’s talk about some specific parts of the rules

 

The ICD-10-PCS codes have “7” characters and give exact details about each procedure. Each character has a specific job in ensuring the details are correct.

 

If different body parts get the same treatment during one procedure, they need the right codes.

 

When doing a biopsy, use codes like Excision, Extraction, or Drainage, along with “Diagnostic,” to describe it.

 

To code a bypass surgery correctly, you need to say which body part is being bypassed “from” and which one is being bypassed “to.”

 

Although we no longer use history and exams for E/M services, they’re still important when reporting specific CPT codes (99202-99215). Now, the level of E/M service depends on the medical decision-making (MDM) level and the length of the visit.

 

The time linked with CPT codes 99202-99215 has changed. It now refers to the total time spent with the patient on the visit day, not just face-to-face time.

 

The MDM for codes 99202-99215 now includes three updated parts: 1) How many and how complicated the problems managed are 2) How much or how complex the data reviewed and analyzed is 3) How much risk there is of complications or death in managing the patient. To pick an E/M service level, you need to meet or go beyond two of these parts.

Understanding How Urgent Care Billing and Coding Works

 

When patients arrive at urgent care centers, the billing and coding process immediately kicks off. This whole system is carefully planned, starting with creating a clear and organized policy for billing and coding.

 

Even though urgent care visits are walk-in, it’s still crucial to gather basic patient information. Receptionists ask for details like the patient’s name, address, date of birth, reason for the visit, insurance info, and more.

 

All this patient information is recorded in Electronic Health Records (EHR) during registration. EHRs help manage records efficiently, saving time and making processes smoother in urgent care centers.

 

The main goal of improving billing and coding is to make more money while spending less on costly collection procedures. We shouldn’t let complicated billing and coding slow down revenue.

 

Urgent care centers can improve their financial management and get paid faster by focusing on efficient billing practices and seeking help from outside experts.

Final Thought 

 

Urgent care clinics need to understand the new CPT code changes in 2023. These changes affect how these clinics bill for medical services, so it’s super important for them to stay updated to make sure they get paid correctly. Here are some helpful resources specifically for urgent care clinics