# BCG and urine culture billing



## nomie7 (Jun 26, 2014)

I was hoping someone could help me with the following coding situation. Our office does BCG instillations. It is protocol to have the patient come into the office a week before the scheduled BCG instillation, and submit a urine specimen to be sent to an outside lab for culture. When we are sending orders for Medicare patients, we have run into the problem of non-coverage on the lab charge for the urine culture as it was sent with a non-covered diagnosis code on the order. The order will have been sent with 188.9. I have copied and paste below what the chart note looks like for one of these such encounters. The patient will have previously been diagnosed with a Medicare covered diagnosis codes such as 788.63, 788.43, or 599.72; but that is not documented on this particular DOS. Does anyone have any thoughts of what diagnosis code should be billed that is covered? Is this service just not covered? I have considered V58.69 that is on the Medicare NCD list.

"Nursing Intake 
Vital Signs 
Ht: 68 in.  
Comments: _________ came in today to drop off a urine specimen prior to BCG treatment. Urine was sent to Legacy for culture. 


Urinalysis-Macro: 
Glucose(mg/dl):Neg         Normal: Negative
Bilirubin:Neg              Normal: Negative
Ketones:Neg                Normal: Negative
Specific Gravity:1.025     Normal:1.000-1.030 
Blood:Neg                  Normal:Negative
pH:6.0                     Normal:4.5-8.0 
Protein:Neg                Normal:Negative
Urobilinogen(mg/dl):0.2    Normal:<2.0 
Nitrite:Neg                Normal:Negative
Leukocytes:Neg             Normal:Negative


Plan 
New Orders: 
Urinalysis [CPT-81003]
Specimen handling fee [CPT-99000]
CULTURE-URINE [PHS91580/654523]




PLAN:
His urine will be sent for culture and sensitivity. If it is negative, he will proceed with his next BCG."


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## Kelly_Mayumi (Jul 2, 2014)

Yes, 99000 is a non-covered service by medicare.  Looks like it hasn't been covered since 2000?


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## nomie7 (Jul 7, 2014)

I was looking for an ICD-9 to be put on the order for the urine culture (87088).


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