The Roadmap to Understanding Urgent Care Billing CPT Codes
Josh Knoll
Why is there so much confusion regarding urgent care billing codes?
The urgent care billing and coding process is complex and overwhelming, there is no denying that. This complexity leads to significant confusion among medical billers, often resulting in additional cost.
Below are some of the factors that contribute to this confusion:
1. Coding system complexity
2. Evolving guidelines
3. Inadequate training
4. Multiple code options
5. Lack of standardization
6. Unique codes for health plans like Medicare and Medicaid
What are the most commonly used urgent care CPT codes and how are they different from each other?
The CPT codes have been defined by the U.S. Department of Health and Human Services. Following are the most commonly used CPT codes in UC and their uses as defined by the American Medical Association (AMA):
1. 99213 – This is the most commonly used CPT code. It is used for moderately complex visits by established patients.
2. 99214 – This is the second most common code in UC and is used for complex visits by established patients.
3. 99204 – This code is the third most common CPT code and is meant for new patients requiring complex treatment or services.
4. 99203 – This is the fourth most common code and is used for new patients requiring complex treatment or services.
5. 99212 – This code is used for established patients requiring slightly less complicated healthcare procedures. This is also the least used UC CPT code.
What are some best practices to eliminate this confusion in urgent care billing codes?
Urgent care billing and coding errors can be reduced significantly by following some of the below mentioned best practices:
1. Continuous education and training: Investing in training programs for staff, staying updated on urgent care CPT code guideline changes, and attending workshops will help the billing team eliminate knowledge gaps.
2. Documentation accuracy: Detailed and accurate documentation is indispensible in order to ensure accurate billing. Proper processes must be put in place to ensure all relevant patient information is collected and stored accurately.
3. Regular audits and review: Urgent care centers must carry out regular audits and reviews of their operational procedures to ensure they have necessary processes in place to document every step if the patient’s journey.
4. Leveraging technology solutions: Use of Electronic Health Record (EHR) and similar software to capture and store patient data can reduce manual errors drastically.
Can outsourcing urgent care billing to a revenue cycle management company be a better option?
A simple answer to this question is that, if done properly, outsourcing urgent care medical billing and coding services is the most cost effective way to reduce billing and coding errors.
Outsourcing brings a host of advantages and benefits that an in-house team of medical billers and coders can rarely match up to. Reduced labor cost, increased billing accuracy and optimized revenue are some of the benefits to outsourcing.
In addition to these advantages, outsourcing to a HIPAA-compliant revenue cycle management company ensures data security, which is one of the main concerns that healthcare providers have.