Table of Contents
Below is a detailed cheat sheet tailored for medical coders working with urgent care cpt codes. We focus on key codes, modifiers, and billing tips.
1. Commonly Used Urgent Care ICD-10-CM Codes
Minor Illnesses
- J06.9: Acute upper respiratory infection, unspecified.
- N39.0: Urinary tract infection, site not specified.
- R50.9: Fever, unspecified.
- R05: Cough.
Injuries and Trauma
- S93.4XXA: Sprain of ankle, initial encounter.
- S01.01XA: Laceration without foreign body of scalp, initial encounter.
- S52.131A: Greenstick fracture of right radius, initial encounter.
- T14.91XA: Injury, unspecified, initial encounter.
Diagnostic and Preventive Encounters
- Z00.00: General adult medical examination without abnormal findings.
- Z23: Encounter for immunization.
- Z02.89: Encounter for other administrative examinations (e.g., work physical).
- Z13.6: Encounter for screening for cardiovascular disorders.
2. Key Urgent Care CPT Codes
Evaluation and Management (E/M) Codes
Urgent care often relies on E/M codes reflecting the complexity of the visit:
- 99202–99205: New patient office visits.
- 99211–99215: Established patient office visits.
Procedures and Diagnostics
- 69210: Removal of impacted cerumen (one or both ears).
- 12001–12021: Laceration repair (based on length and complexity).
- 93000: Electrocardiogram with interpretation and report.
- 36415: Collection of venous blood by venipuncture.
- 71045: Chest X-ray, single view.
Preventive Care and Vaccinations
- 90471: Immunization administration (single vaccine).
- 90658: Influenza virus vaccine, trivalent.
- 87880: Rapid strep test.
- 99050: Services provided after hours.
3. Modifier Guide for Urgent Care CPT Codes
Commonly Used Modifiers
- -25: Significant, separately identifiable E/M service on the same day as a procedure.
Example: E/M service billed alongside a flu shot or laceration repair. - -59: Distinct procedural service.
Example: Separating an E/M code from a minor procedure, like a diagnostic X-ray. - -95: Telehealth services provided synchronously via audio and video.
- -76/77: Repeat procedure or service by the same or a different provider.
4. Best Practices for Urgent Care CPT Codes
Documenting for Accuracy
- Clearly describe the presenting problem, procedures performed, and treatment plan.
- For injuries, include external cause codes (e.g., W19: Fall, unspecified).
- Include time-based codes when applicable, such as for prolonged services.
Preventing Denials
- Verify insurance eligibility before the visit.
- Attach appropriate modifiers to avoid bundling issues.
- Double-check that ICD-10 codes match the specificity required by payers.
Billing for Bundled Services
Many urgent care visits involve multiple services. Use modifiers like -59 to ensure that diagnostic procedures, treatments, and E/M codes are appropriately billed.
5. Managing Telehealth in Urgent Care
Common Telehealth Codes
- G2025: Telehealth visit under the CARES Act.
- 99212–99215: E/M services provided virtually.
- 99421–99423: Online digital E/M services based on cumulative time over seven days.
Documentation Tips: Include the mode of communication, start and end times, and the patient’s consent for telehealth.
FAQs for Urgent Care Coders
Q: Can I bill for both an E/M visit and a procedure on the same day?
Yes, but append Modifier -25 to the E/M code to indicate that it is separate and significant from the procedure.
Q: Are rapid tests (like flu or strep) reimbursable?
Yes. Use codes like 87804 (rapid flu test) or 87880 (rapid strep test) with the appropriate diagnosis code for the patient’s symptoms.
Q: What happens if a payer denies a bundled service?
Review the explanation of benefits (EOB), add a Modifier -59 if applicable, and resubmit the claim with detailed documentation.
Q: How do I code for after-hours services?
Use 99050 for services rendered after regular hours, if the payer allows additional reimbursement for this code.
Q: Can I bill for telehealth services provided by an urgent care provider?
Yes, as long as the service is synchronous and documented properly. Use codes like 99212–99215 with Modifier -95 to indicate telehealth delivery.
