# Coding for Urinalysis with an Office Visit



## Carroll1220

Good afternoon,

I sent a claim in to Medicare for a patient who had a Urinalysis done in the office by the provider the same day as they had an office visit. On the claim I submitted a CPT code as 81015-Urinalysis, bacteriuria screen microscopi only and put the charge next to it and on the second line I billed a 99212 for the Office Visit with a Modifer 25. I did not put a charge next to this because the E&M was done the same day. Medicare sent it back saying that there were errors in billing. Would someone please be able to send some light on the subject? Should I just not include the 99212 E&M portion and only bill for the urinalysis?

I would really appreciate feedback on this as I do not have any coders in the office to ask about this.

Thank you so much for your help!
Noelle


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## Leenahz

Hi Noelle,

I'm sorry, I'm a bit confused as to why you wouldn't charge the 99212 if the patient was indeed seen and treated by the physician for the problem?  I wouldn't use a 25 modifier in this instance.  Was the urinalysis ordered by a different provider?  Also, I'd look at your other u/a codes.  CPT 81015 is for microscopic analysis.  Typically, I see 81000 or 81002.   Please let me know if I misread something.

Lena


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## Carroll1220

Hi, Lena!

Thank you so much for your response! The physician did the urinalysis himself in his office with a microscope and they bill a flat rate for the service. When I submitted the CMS 1500 form, I put the charge with the urinalysis code and then on the next line, put the E&M code 99212 with a modifier 25 next to it and did not put an amount because I had put the charge to the urinalysis code. 

Would the urinalysis code be bundled in with the 99212 code? Or should I find out from the provider the charge of the urinalysis code and bill each separately with their respective costs? I appreciate your assistance with this!

Thank you for your help!
Noelle


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## teresabug

You will need to bill out an amount on each charge line. Does your office use a universal charge master? Some offices have their billed amounts set as 30%above the MEdicare fee schedule amount for your locality. The accountant would be able to advise. Does your office have a practice manager? He/She would be the one responsible typically for this. What type of specialty is your provider?


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## Leenahz

Carroll1220 said:


> Hi, Lena!
> 
> Thank you so much for your response! The physician did the urinalysis himself in his office with a microscope and they bill a flat rate for the service. When I submitted the CMS 1500 form, I put the charge with the urinalysis code and then on the next line, put the E&M code 99212 with a modifier 25 next to it and did not put an amount because I had put the charge to the urinalysis code.
> 
> Would the urinalysis code be bundled in with the 99212 code? Or should I find out from the provider the charge of the urinalysis code and bill each separately with their respective costs? I appreciate your assistance with this!
> 
> Thank you for your help!
> Noelle



Hey Noelle,

I'm in agreement with Teresa.  Each line item should have a separate charge.  Example:

99212 $75.00
81015 $15.00

Total claim amount: $90.00

Also, I don't see where a modifier 25 is necessary.  

Hope this helps!
Lena


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## nrichard

*QW*

Modifier 25 is not needed. What they payer wants to know, is if your office meets the criteria for Clia Waved Labs and has a Clia Certificate on file.  If your office has Clia Certificate, you would bill the UA with QW modifier.


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