Primary Care & Urgent Care Billing

Common workstreams

• New and established patient office/outpatient E/M services.
• Preventive visits and screenings.
• Minor procedures, injections and in-office testing.
• Care-management and longitudinal services when applicable.
• Urgent presentations with rapid testing or treatment.

E/M documentation

Office/outpatient E/M coding depends on the current coding rules for medical decision making or qualifying time when time is used. Billing staff should confirm that the selected service is supported by the documented encounter rather than inferring complexity from the diagnosis list alone.

Same-day services

A visit and a procedure performed on the same date do not automatically mean both are separately payable. The team should verify whether the E/M work is separately identifiable, whether a modifier is appropriate, and whether the payer has additional edits.

Preventive versus problem-oriented

Preventive benefits can have different patient cost sharing and coverage rules from problem-oriented care. If a patient receives both preventive and medically necessary problem-oriented work, the documentation and claim should accurately reflect what occurred and follow payer-specific guidance.

Quick knowledge check