Urgent Care Billing and Coding Guidelines 2023

Urgent care centers are experiencing explosive growth as the healthcare landscape evolves. The capacity of these facilities to offer affordable, quick, and efficient healthcare services is what drives their popularity. In fact, most urgent care facilities have a 30-minute or less wait time, and most visits last an hour or less. The urgent care market is so trending that private insurance claim lines for urgent care services increased by 1,725% between 2007 and 2016. As growth continues, the market is expected to reach $26 billion in 2023. Although the urgent care market is thriving, urgent care centers risk losing a significant amount of money if they make billing and coding errors. Making billing and coding errors costs more than a few cents; it can mean the difference between a successful and unsuccessful center. That’s why there is a need to be aware of the urgent care billing and coding guidelines to be followed in 2023. Here’s a closer look at the billing and coding guidelines of urgent care in 2023:

An Overview of Guidelines 2023

The billing processes for Primary Care and Urgent Care are nearly identical as they both treat identical problems. However, a few medical codes are specific to urgent care billing services. These codes begin with the letter “S.” There are two code groups that pertain to all urgent care services except Medicare for billing purposes, and these are as follows:

  • S9083

The urgent care billing code S9083 allows the facility to charge a single service fee regardless of the patient’s treatment plan. In some cases, a Managed Care Organization (MCO) may require a hospital to bill using the S9083 urgent care billing code. Indeed, several MCOs in states such as Florida and Arizona need urgent care facilities to bill all services under S9083.

  • S9088 

It is also known as “services provided in an Urgent Care center (list in addition to code for service).” This code allows urgent care facilities to bill for medical diagnosis and treatment while recognizing the exorbitant services provided in an urgent care facility. Moreover, the S9088 code must be used in conjunction with the appropriate evaluation and management (E/M) code. In addition to this, the urgent care billing code S9088 allows centers to be reimbursed for a portion of the increased cost of providing immediate care.

Most Common Urgent Care CPT Codes

E/M codes account for the majority of CPT codes in urgent care centers. The following are some of the most commonly used CPT codes in an urgent care setting:

  • CPT Code 99214
  • CPT Code 99213
  • CPT Code 99204

Changes in Urgent Care CPT Codes

The Centers for Medicare & Medicaid Services (CMS) annually issues new updates that can significantly impact claim submission. To submit accurate claims, urgent care centers should stay updated on changes to codes and payer rules and regulations. Here are a few updates in the urgent care CPT codes:

  • Although the exam and history are not used to choose an E&M service, they must be performed to report CPT codes 99202-99215.
  • The selection of E&M codes is used based on the following:
  • The level of medical decision-making (MDM) OR
  • The time performing the service on the encounter day
  • The time definition for CPT codes 99202-99215 has been changed from typical face-to-face time to total time spent on the encounter day.

How Should Urgent Care Billing & Coding Be Handled in Centers?

Urgent care billing company tasks can be highly demanding. As a result, handling these procedures internally is not a good idea from an economic or strategic standpoint. Maintaining compliance with constantly changing rules and regulations is another difficult task for physician facilities. The industry is rapidly evolving, so coding for urgent care medical billing is unusual.

All this can quickly be dealt with by outsourcing urgent care billing and coding operations to an experienced medical billing company, such as 24/7 Medical Billing Services. Our dedicated team of medical billers and coders can help you grow your business. Reduced risk of claim denial and refusal is achieved through rapid, real-time, accurate, and error-free coding of each claim and early evaluation to ensure claim eligibility. Our team closely monitors all Medicare urgent care billing and coding guidelines to maximize reimbursement. Book an appointment with our team to know more about urgent care billing and coding guidelines in 2023.

Read more: Why Outsource Urgent Care Billing Services?

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