Ob-Gyn Coding Alert

Question:  If we do a urinalysis (UA) dipstick test in the office lab and find an abnormality that causes us to send the specimen to an outside lab for a UA with micro and a culture, should we charge only for handling the specimen?

Ohio Subscriber

Answer:  No, the handling code 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory) would not be reported unless you incurred expenses over and above that required as part of your overhead costs for this particular patient. If all you are doing is filling out paper work for the lab to pick up the sample, your costs would be part of your doing business.  But you should be charging for the UA that you performed. 

You should bill for the work that you perform in your physician office lab, which is a dipstick UA. Report the service using the appropriate code, such as 81003 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy). You’ll need to look at your dipstick methodology and package insert to select the proper code.

Remember modifier: As a physician office lab, you may be operating under a certificate of waiver under the Clinical Laboratory Improvement Amendments (CLIA). If that’s the case, you’ll need to ensure that your lab is using a CLIA waived test, and report the UA dipstick code with modifier QW (CLIA waived test). You can find a list of CLIA-waived tests at www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/CategorizationofTests.html.