Medicare Compliance & Reimbursement

Question: We have a patient who did not have a urinalysis done at his previous well visit, but then needed it done for his basketball camp form. The patient did not have any problems or issues with urination, just needed it for his camp form records. What diagnosis code could we use to submit this service to his insurance company? If we use the well child diagnosis code, the insurance may not pay for the actual well visit diagnosis code when the patient needs it.

Answer: Unfortunately, you will likely not be reimbursed by the insurance company for this service. Most payers will not reimburse a urinalysis for a camp form when there is no other reason for the urinalysis.

Under these circumstances, consider collecting from the patient -- probably $5-$10 based on the payer’s fee schedule -- and then reimburse the patient if the submitted claim is paid. You may also ask the patient to sign a waiver or an advanced beneficiary notice, (ABN), accepting financial responsibility if the claim for the urinalysis is denied.

To bill the insurance, use 81000 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy) and as a secondary diagnosis add ICD-9 code V72.60 (Laboratory examination, unspecified).