CPT Codes for Urgent Care: Guidelines 2023

Urgent care centers are a popular option for patients seeking immediate medical attention for injuries or illnesses that are not life-threatening. As opposed to waiting hours in an emergency room or trying to get an appointment with a primary care physician, urgent care allows patients to be seen quickly for episodic care.

With the rapid growth of urgent care centers across the US, these facilities must adhere to proper coding and billing practices. Correctly using CPT (Current Procedural Terminology) codes is crucial for urgent care centers to receive accurate and timely reimbursement.

CPT codes are a standardized numerical system that describes medical procedures and services. Each CPT code has a defined reimbursement rate set by Medicare and private insurers. Proper CPT coding helps avoid denied claims or underpayment.

Today’s post provides a comprehensive overview of urgent care CPT codes. It will cover coding guidelines and updates for 2023 that urgent care coders need to be aware of. With frequent changes to CPT codes each year, it is critical for urgent care staff to stay updated on the latest regulations surrounding medical coding. Accurate coding ultimately allows urgent care centers to be properly reimbursed for treating patients quickly and efficiently.

Urgent Care CPT Codes

Strong knowledge of the common urgent care CPT codes is essential for accurate billing and reimbursement. Here are some of the most commonly used codes:

Evaluation and Management (E/M) Codes

Within the intricate landscape of medical coding, Evaluation, and Management (E/M) codes stand as a unique subset that holds significant importance in urgent care settings. These codes are designed to capture the complexity and nuances of patient encounters, encompassing clinical evaluation and medical decision-making.

Some urgent care CPT codes are listed below:

• E/M codes 99201-99205 are used for new patient visits, with higher levels indicating more complex cases
• E/M codes 99211-99215 are used for established patient visits with higher complexity at higher levels
• Critical care codes 99291-99292 are sometimes used for severe cases
• Observation care codes 99217-99220 cover prolonged visits without hospital admission

Procedures

When a patient arrives with a laceration, urgent care practitioners have an array of techniques at their disposal to facilitate healing. Urgent care CPT codes 12001-13160 encompass a spectrum of wound repair options, from simple to complex closures involving sutures, staples, and tissue adhesives.

• Incision and drainage codes 10060-10180 are used for draining abscesses
• Foreign body removal codes 20525-20553 are for taking out splinters or embedded objects
• Splint and cast application codes 29000-29799 are used when immobilizing fractures

Diagnostic and Laboratory Testing

Diagnostic imaging is integral to assessing and diagnosing various medical conditions in urgent care settings. CPT codes 70010-76999 encompass radiology procedures such as X-rays, CT scans, and MRIs. These codes cater to different body regions and imaging modalities, reflecting the intricate nature of diagnostic tests. Accuracy in coding ensures that the specific procedure performed is properly documented, allowing for transparent communication with insurance providers.

From blood tests to urinalysis, laboratory tests provide critical insights into a patient’s health status. Urgent care billing codes 80047-89398 encompass various laboratory procedures for specific medical contexts and diagnostic purposes. Proper coding ensures the correct test is linked to the appropriate diagnosis, forming a crucial bridge between clinical assessment and financial reimbursement.

Electrocardiograms (EKGs) and electrocardiograph (ECG) services are essential for assessing cardiac health. CPT codes 93000-93799 encompass a variety of cardiac diagnostic procedures, reflecting the diverse aspects of heart monitoring and evaluation. These codes distinguish between different types of EKG/ECG procedures and account for interpretations and additional components, ensuring accurate representation for billing purposes.

Vaccine Administration

Urgent care centers often administer immunizations and vaccinations to prevent and manage diseases. Urgent care billing codes 90460-90749 cover various vaccine administration codes, accounting for the number of vaccines administered and the patient’s age. Coding accuracy is crucial to convey the vaccine type and quantity, supporting patient care and appropriate reimbursement.

2023 Urgent Care CPT Codes Updates and Changes

Urgent care coders must review all 2023 CPT code changes and understand proper usage to ensure accurate billing and reimbursement under the new guidelines. A careful review of revised urgent care CPT codes that combine or replace old codes to avoid submitting invalid codes is important.

Evaluation and Management Changes

• New prolonged services code 99417 for visits lasting over 59 minutes
• Revised office/outpatient E/M code descriptors to remove references to time
• E/M code level selection is now based on medical decision-making or total time
• Updated counseling and coordination of care guidelines

Procedure Code Changes

• Revised wound repair codes 12001-13153 better to capture complex repairs by anatomic site and technique
• New codes for antibiotic and contrast injections for imaging studies
• Added codes 62267, and 62268 for percutaneous epidural adhesiolysis procedures
• Revised guidelines for neurostimulator codes 95970-95982

Lab/Diagnostic Changes

• New codes 89290-89294 cover cell enumeration of different body fluids
• New codes 89321-89325 for genomic sequencing procedures
• Revised microscopic urinalysis urgent care CPT codes 81001-81003

Urgent Care CPT Coding Guidelines and Tips

Following coding best practices optimizes reimbursement and avoids denied claims. Ensuring the entire staff is trained on proper coding is also essential.

Here are the best practices and tips for urgent care billing codes:

• Use E/M code 99205 for complex cases requiring comprehensive history, exams, and decision-making
• For minor conditions, 99201 may suffice
• Make sure the E/M service level matches the documentation
• Use modifier 25 on E/M codes to indicate significant, separately identifiable services on the same day as other procedures
• Add modifier 59 to procedure codes when distinct from other procedures performed
• When a vaccine supply is given, report the vaccine code + administration code
• Use the most specific ICD-10 diagnosis codes supported by documentation
• Verify that the billed CPT codes have not been discontinued or changed for the current year before submission

See Also: New Cpt Codes 2023: Is Your Practice Ready?

Conclusion

Accurate CPT coding is essential for urgent care centers to receive proper service reimbursement. Coders must stay up-to-date on the latest CPT guidelines and changes that take effect each year regarding urgent care CPT codes. Key annual changes impacting urgent care coding for 2023 include revisions to evaluation and management services, wound repair codes, and new genomic sequencing codes.

Following coding best practices, using specific ICD-10 diagnoses, and ensuring complete documentation will help avoid claim denials and underpayment. With increasing coding and billing regulations complexity, many urgent care centers find it beneficial to leverage specialized medical billing services.

Precision Hub offers outsourced urgent care billing and coding by certified experts. Our team stays current on all coding updates and guidelines to optimize reimbursement for your clinic. We also provide regular coding audits. With Precision Hub’s urgent care billing services, you can focus on delivering quality care while maximizing your revenue. Our team is ready to help you get paid accurately and efficiently for the vital services you provide. Contact us today.