Pathology/Lab Coding Alert

Question: A physician ordered a urinalysis with a reflex to urine culture for findings of hematuria. How should we code this?

Ohio Subscriber

Answer: The correct coding depends on the lab methods, so your question could have many correct answers. Let's run down the possibilities:

For the initial urinalysis, select from the following codes based on lab method:

• 81000 -- Urinalysis, by dipstick 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.

If the urinalysis shows blood in the urine, you'll need to select the proper ICD-9 code to establish medical necessity for the ensuing urine culture. You'll either report 599.71 (Gross hematuria) or 599.72 (Microscopic hematuria) depending on whether the lab diagnosed the blood in the urine based on a visible condition (pink or brownish urine) or based on a microscopic exam. You should have enough information to avoid using the unspecified code (599.70, Hematuria, unspecified).

Choose culture code: In addition to the urinalysis, you should list the urine culture as 87086 (Culture, bacterial; quantitative colony count, urine). That's as far as you'll go if the culture is negative. If the culture isolates an organism, however, you'll need to list an additional code for the presumptive identification: 87088 (... with isolation and presumptive identification of each isolate, urine).

Watch the lab report for additional culture testing for a definitive identification or culture typing -- you'll need additional codes to capture those services, if performed.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.