Pathology/Lab Coding Alert

Question: How should we report a standard chemical urinalysis test to evaluate urine constituents such as glucose, hemoglobin, protein, etc.?

New Hampshire Subscriber
 
Answer: There are four codes for the service you describe: 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) and 81003 ( automated, without microscopy).
 
Adhering to coding guidelines can help avoid denials for this common test:  
 
1. Medicare and many other payers cover the test only for diagnostic purposes for a variety of suspected conditions. Check payer guidelines, such as your carrier's local medical review policy (LMRP), to ensure that the test is ordered only for payable symptoms or diagnoses. Many payers restrict the frequency at which repeated urinalysis tests will be covered.
 
2. Do not fragment the service and report it with multiple codes if a single code describes the service. For example, if the lab carries out a nonautomated dipstick urinalysis with microscopic evaluation, report one unit of 81000, not 81002 plus 81015 (urinalysis; microscopic only). CCI edits do not allow the various urinalysis codes to be reported together because they represent different methods of doing the same test.
 
3. Routine chemical urinalysis is included in certain patient encounters, such as antepartum care. When any of the urinalysis tests 81000-81003 are carried out in such settings, the test is not separately reportable. 
 
4. Reimbursement problems have surfaced from various carriers and third-party payers over time for the urine dipstick (81002) when reported with an E/M service. Physician office labs often do this test. The problem apparently stems from an old CCI edit that bundled 81002 with E/M codes in the range of 99201-99360. 
 
5. Code 81002 is granted waived status under the Clinical Laboratory Improvement Amendments (CLIA). If a CLIA-waived lab performs the test, it must be reported with modifier -QW (CLIA-waived test) to be reimbursed.

  Answers to Reader Questions and You Be the Coder provided by R.M. Stainton, MD, president of Doctor's Anatomic Pathology in Jonesboro, Ark.; and Laurie Castillo, MA,CPC, CPC-H, CCS-P, president of Physician Coding and Compliance Consulting in Virginia.