Are you confusing emergency codes with urgent care? While they might seem similar, ER E/M codes should never be used for urgent care services. Gaps in primary care, expensive emergency department visits, increasing healthcare demands, and investments have made walk-in clinics more popular.
In fact, the number of urgent care centers has nearly doubled over the last decade. Today, there are over 10,728 active urgent care centers across the country. However, despite their growth, they experience complex billing requirements and denials. If inaccurate coding is your problem, read on to learn about the most used urgent care CPT codes for 2024.
Understanding Urgent Care Services
People often confuse urgent care with emergency care. That’s why they make coding mistakes. While both provide immediate medical attention, they are quite different. In fact, urgent care is an excellent, cost-effective alternative to emergency care, preventing around 24.5 million ER visits annually.
The main difference? Urgent care centers, also known as walk-in clinics, treat time-sensitive, non-life-threatening conditions, such as:
- Minor headaches
- Stomach aches
- Ear and sinus infections
- Superficial injuries or burns
- Sprains and strains
- Allergies
So, do you only visit these facilities for a cough or cold, like most people? Or do you know that these centers also provide the following services?
- Stitches
- X-rays
- Casts and splints
- Flu shots and other immunizations
- Blood pressure tests
- Urinalysis and other lab tests
What CPT Codes are Commonly Used for Urgent Care in 2024?
Here are some of the most frequently used CPT codes for urgent care services:
Urgent Care CPT Codes for Evaluation & Management of Patients
CPT Codes 99201 to 99205 – Evaluation & Management of New Patients
These four urgent care CPT codes, from 99201 to 99205, focus on examining a new patient for a specific time. Moreover, they address different types of medical decisions. Healthcare providers use these codes to bill for evaluation and management services, which usually involve doctors assessing and recommending treatments to new patients for minor injuries or infections.
| CPT Code | Description |
|---|---|
| 99202 | Covers a 15-minute problem-focused office visit and simple decision-making |
| 99203 | Specifies a more detailed office visit, lasting up to 30 minutes or more, and standard medical decisions. |
| 99204 | Defines a 45-minute thorough examination and intermediate medical decisions. |
| 99205 | Points towards a detailed office visit, up to an hour or more, requiring complex decision-making |
CPT Codes 99212 to 99215 – Evaluation & Management of Established Patients
To urgently evaluate an established patient, you can use CPT codes from 99212 to 99215. These CPT codes for urgent care visits are quite similar to E/M codes for new patients. However, they cover different time limits and cover follow-up visits.
Doctors use these codes to claim reimbursements for taking problem-focused histories of returning patients, which may include physical exams and different levels of decisions.
| CPT Code | Description |
|---|---|
| 99212 | It covers a 10-minute focused history of an established patient. |
| 99213 | Addresses a 20-minute office visit in an urgent setting with targeted examination and basic decisions. |
| 99214 | Indicates a detailed analysis of an established patient, lasting more than 30 minutes, to diagnose and treat the established patient. |
| 99215 | Used to bill a comprehensive 40-minute examination. |
Urgent Care CPT Codes for Superficial Wound Care
CPT Codes 12001 to 12007 – Simple Wound Repair
Urgent care also includes treatment for minor injuries. Hence, the urgent care CPT code list ‘12001 to 12007’ is quite common. These codes refer to the simple care for superficial wounds in different body parts, such as the scalp, neck, trunk, axillae (armpit), external genitalia, and extremities.
These urgent care CPT codes categorize wound care according to the size of the injury.
| CPT Code | Description |
|---|---|
| 12001 | Covers simple repair of 2.5 cm or lesser-sized wounds on the scalp, neck, trunk, axillae, external genitalia, or extremities. |
| 12002 | Addresses superficial wound treatment for a 2.6 to 7.5 cm injury in the areas mentioned above. |
| 12004 | Specifies basic suturing for a 7.6 to 12.5 cm wound. |
| 12005 | Highlights basic wound care for a 12.6 to 20 cm-sized injury. |
| 12006 | Defines primary care for wounds that are 20.1 to 30 cm in size. |
Urgent Care CPT Codes for Minor Burns
CPT Code 16000 – First-Degree Burn Care
Walk-in care centers are an excellent place for treating minor burns. So, what is the most commonly used urgent care CPT code for this service? Healthcare providers use CPT code 16000 to bill for emergency treatment of first-degree burns. This includes washing the affected area with cold water and wrapping it with sterile gauze to prevent infection.
Urgent Care CPT Codes for Incision & Drainage Procedures
CPT Code 10060 – Abscess Incision & Drainage
This urgent care CPT code covers a simple treatment of an abscess (pus buildup). This includes a healthcare provider making a small cut to drain the trapped pus from a paronychia (boil) or carbuncle (cluster of boils), cyst, or an infected wound.
In simple words, billing specialists use the 10060 CPT code when the abscess is close to the skin’s surface and does not require extensive treatment or procedures.
CPT Code 10140 – Hematoma/Seroma Incision & Drainage
This is another common urgent care office visit CPT code. The 10140 CPT code specifically highlights the incision and drainage of a hematoma (a pool of clotted blood), seroma (a pocket of clear fluid that usually develops after surgery), or other fluid collections under the skin.
Simply put, healthcare providers use this code to indicate that they made a small cut in the patient’s skin to release the fluid buildup due to an injury, surgery, or infection. This procedure helps patients avoid further complications.
Urgent Care CPT Codes for Splint & Cast Applications
CPT Code 29125 – Rigid Splint Application (Forearm)
This urgent care CPT code specifies the application of a rigid (static) splint on the lower arm, usually from the patient’s elbow to the palm. Healthcare providers in urgent care settings apply this splint to stabilize the broken or cracked bone due to a sports injury or any other accident.
In short, urgent care facilities use the 92125 CPT code to document and bill for managing a patient’s forearm arm fracture.
CPT Code 29515 – Short Leg Splint (Lower Leg)
This urgent care CPT code allows you to collect payment for applying a short leg splint. This splint treats several lower leg injuries, including fractures, dislocations, and sprains. Urgent care healthcare providers use this splint to immobilize the leg, usually from below the knee to the foot, to promote healing.
Urgent Care CPT Codes for Immunizations
CPT Code 90657 – Influenza Vaccine (3-Strain)
Urgent care centers also offer flu shots. The 90657 CPT code for urgent care refers to the 3-strain influenza (flu) vaccine, also known as the trivalent Inactivated Influenza Vaccine (IIV3). It is very safe to use because it is split. It means that it contains an altered, inactivated form of the virus.
Healthcare providers inject 0.25 mL of this vaccine into the muscles of children aged 6 and 35 months to protect them from three different types of influenza. It is usually administered as part of the seasonal flu vaccinations.
Exclusive Urgent Care HCPCS Codes
While primary and urgent care services often overlap, the latter covers a wide range of conditions. There is also another major difference between these two specialties. Urgent care-specific Healthcare Common Procedure Coding System (HCPCS) codes start with the capital letter ‘S’. Here are the two commonly used HCPCS codes by emergency medicine physicians.
S9083 – Global Fee for Urgent Care Services
This is a special level II one-size-fits-all HCPCS code for urgent care. It allows doctors to bill all the provided services in a single visit under one global fee. In simple words, this code covers everything at a single, flat rate during a single patient encounter.
For example, consider an E/M office visit, where a healthcare provider conducted several tests to diagnose the patient. Instead of filing separate claims for each service, the billing team will use the S9083 HCPCS code to report the entire visit.
Hospitals usually use the S9803 code when Managed Care Organizations—companies utilizing a managed care model to maintain healthcare quality—are involved in the reimbursement process. This code minimizes the coding staff’s workload. Keep in mind that you cannot use this code for Medicare claims.
S9088 – Higher Reimbursements for Urgent Care
This is an add-on HCPCS code for all unscheduled urgent care visits (E/M). Since some emergency services are more expensive than traditional primary care treatments, you can use the S9088 code to receive higher reimbursements. Remember that this code only covers a significant portion of the increased costs. Like S9083, Medicare does not require this code.
Conclusion
Urgent care facilities are quite affordable and convenient. Hence, their patient volume continues to increase over time. While this signals significant potential in this specialty, it also creates a major challenge for urgent care providers: maintaining billing and coding accuracy.
The financial health of your practice heavily depends on how well you understand the ever-changing billing and coding guidelines. We have provided the most commonly used urgent care CPT codes so you can overcome this challenge.
However, if you don’t have the time to keep up with coding updates or the resources to hire in-house billing staff, outsource your billing operations. Many billing companies offer comprehensive urgent care billing services, which include the accurate reporting of CPT codes used for urgent care. Focus on treating the non-life-threatening conditions of your patients and leave coding to the experts.
