Tomorrow I am going to one of our new practices. It is an Urgent Care facility. I have a couple of tasks to perform and look forward to the time I will be there.

My first task is to discuss the S9083 Urgent Care Global code. When we took over this practice we found a lot of EOBs rejecting the code and a good many with other anomalies regarding the use of S9083. The medical billing personnel handling the claims before we took over, did not have a grasp for this type of facility. Primarily, for this practice, Aetna is the only company using the global code although they have contracts that state otherwise. When a patient came into the practice and utilized several services, their medical billing would use a line item for each service. For example, say the patient had lower back pain, so along with the E&M code they did a urinalysis and a lower back x-ray.

Now for a regular office visit we would have three separate charge items, the E&M 9XXXX, the urinalysis 8XXXX, and the x-ray 7XXXX and that works fine. What the billing had done was to use the old strategy but replace the above three codes with S9083 and they created three line items of S9083. Unfortunately they charged different amounts for the same code. For the office visit they charged $100.00, for the urinalysis they charged $20.00 and for the x-ray they charged $75.00. Well insurance companies being insurance companies, naturally they paid for the $20.00 charge and claimed the other items are duplicate charges which from the standpoint of the procedure codes, they do appear to be.

The practice should have only charge the SXXXX code in place of the E&M (9XXXX) code and utilized the other codes as they were represented in the CPT list. They would have at least gotten the $100.00 allowed and likely had the CPT codes rejected. Unfortunately, they are now out $80.00 with little chance of recouping the difference. The filing limit has passed. It would be okay if this was an isolated incident but it was ongoing. At the least we will put an end to the loss from that standpoint.

In addition to the S9083 code there is an S9088 add on code. Although most companies may not recognize this code and pay it, at least we should be asking for it. If we don't ask we will not get. So for those companies that accept the CPT codes rather than the HCPCS global code we will attempt to get some additional revenues by using the add on code. In addition, the practice needs input on when to refer the patient to ER and when to keep the patient in-house. Remember, the S9083 code is only generating $100.00 in practice revenues. It cannot therefore afford to spend a lot of its resources on patients that need greater services. These should be considered emergent care and not urgent care. There is a difference!

I am looking forward to helping this practice get a handle on the coding process and generate positive revenues.



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