Pathology/Lab Coding Alert

Question: Our lab performs an automated urinalysis and a urine microscopy exam, but we’re getting denials when we bill 81003 and 81015 for the tests. What is the proper coding for this scenario? 

Ohio Subscriber

Answer: You should report an automated urinalysis with microscopy using a single code: 81001 (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, with microscopy). 

You should not separate the two services and report the following two codes that you mentioned:

• 81003 — … automated, without microscopy

• 81015 — Urinalysis; microscopic only.

Your suggested coding is problematic on two counts. 

First, CPT® coding rules require you to report the most specific code for the provided service. Because there’s a single code that lists the combination of services your lab performs, you should not use the individual codes for those services alone.

Second, Medicare’s Correct Coding Initiative (CCI) edits bundle 81003 and 81015 with a modifier indicator of “0,” meaning that you can never override the edit pair.