Pathology/Lab Coding Alert

Avoid QW for PPMP labs.

Urinalysis (UA) might be one of your lab's most frequently-ordered tests, but that doesn't mean it's one of your most straight-forward coding situations. With multiple CPT® codes for urine constituents, follow our experts' guidelines to increase you UA coding accuracy so you can correctly capture the pay you deserve.

Tip 1: Distinguish Codes by Constituents

CPT® provides the following codes for most urinalysis tests (other than pregnancy tests and a few uncommon UA procedures):

• 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
• 81001 -- ... automated, with microscopy
• 81002 -- ... non-automated, without microscopy
• 81003 -- ...automated, without microscopy
• 81005 -- Urinalysis; qualitative or semiquantitative, except immunoassays
• 81007 -- ... bacteriuria screen, except by culture or dipstick
• 81015 -- ... microscopic only.

10 constituents: Codes 81000-81003 apply to testing "any number" of the listed constituents, so whether you test for one of the items or all of them, you should report a single unit of the appropriate code, says Joan Gilhooly, CPC, PCS, CHCC, president of Ohio-based Medical Business Resources. For instance, a single unit of 81002 would apply to either a non-automated tablet test without microscopy for ketones or a non-automated chem-strip test without microscopy for all 10 elements.

Other than 10 constituents: For UA tests that don't involve the 10 constituents described in 81000-81003, you should choose the appropriate code from the range 81005-81015.

For instance: "If a physician orders a test for other urine constituents such as melanin or reducing sugars (other than glucose), report 81005 (except immunoassays)," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

For a non-dipstick, non-culture test to determine if the urine contains bacteria, report 81007. If the lab performs a stand-alone microscopic examination of the urine without constituent testing, report 81015.

Tip 2: Differentiate Method and Microscopy

Codes 81000-81003 involve a dip stick or tablet reagent test that results in color changes as indicators for any or all of the 10 urine specimen constituents.

To choose the proper code for your case, you must determine whether the test is automated, and whether it includes microscopy, as shown below:

Non-automated: If the tester compares the test result colors to a manufacturer-provided key color chart without using a specialized machine, you should report a non-automated test. Choose either 81000 or 81002 for non-automated UA tests.

Automated: The automated test method involves using a specialized machine to analyze the reaction. For instance, the tester may place the dip stick in a "strip reader" machine that prints out a report, Gilhooly explains. Choose 81001 or 81003 for automated UA tests.

Microscopy: To choose a microscopy code, the provider must analyze the urine sample under a microscope looking for elements such as cells, crystals or bacteria.

Tip 3: Use QW for CLIA Waived Tests

One added element you must consider when coding UA tests is whether to append modifier QW (CLIA waived test) to the CPT® code.

Modifier QW indicates you're reporting a test given waived status under the Clinical Laboratory Improvement Amendments (CLIA). To perform waived tests, a lab doesn't need to meet the requirements mandated for more complicated tests, but the lab does need a CLIA certificate of waiver (www.cms.gov/CLIA/downloads/HowObtainCertificateofWaiver.pdf).

Coding point: The list shows 81002 without QW because the modifier isn't necessary for this code, says Patricia A Trites, MPA, CPC, CEMC, CHCC, CHCO, CHP, CMP(H), CHAP, founder and VP emeritus of Compliance Resources in Sherman, Texas.

All of the tests that fall under 81002 are CLIA-waived, regardless of manufacturer. Consequently, 81002 does not require QW "because the tests are inherently waived and never need to be distinguished from tests that do not have the CLIA-waived designation," explains Helen Avery, CPC, CHC, CPC-I, corporate revenue integrity senior manager with California-based Dignity Health.

In contrast, some 81003 tests are CLIA-waived while others are not. "You would not use QW for 81003 unless the kit/reagent used to perform the test matches both test name and manufacturer as it appears on the list," says Avery.

Don't make QW microscopy mistake: Two codes you won't find on the CLIA-waived tests list are 81000 and 81001. Instead of being CLIA-waived, these codes are on the Provider-Performed Microscopy Procedure (PPMP) list because both require microscopic evaluation of the urine specimen, says Avery.

Your lab can only perform these tests if you have a CLIA certificate of PPMP.

Final caution: "Some states have their own CLIA department in their state HHS [Health and Human Services] divisions," Trites says. When that's the case, "the providers must use the state list and not the federal list to determine which tests are in each of the categories. Many times states will classify tests that are considered waived on the federal list as moderate on their own lists," Trites says.