Pediatric Coding Alert

Question: Should I use CPT 99211 for a patient if the parent just drops off a urine sample, and the nurse does a dipstick test and sends it to the lab for a culture? Should I report 99000? May I bill for the dipstick? And must the patient pay a copayment?

Colorado Subscriber

Answer: You should not report 99211 because there was no patient assessment and no face-to-face contact (handing over the specimen does not count). Similarly, you probably should not bill for 99000 (Handling and/or conveyance of specimen for transfer from the physicians office to a laboratory). This code is to reimburse the physician for the cost of conveying a specimen to the laboratory. If you do not incur a charge, do not report 99000. For example, if the urine specimen is left in the pickup box outside the door, do not charge 99000. Save this code for when you need a result quickly and need to call the lab for a special pickup (which the lab bills you for, allowing you to use that invoice as documentation).

You also can bill for the dipstick test using 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) for a nonautomated test performed with microscopy. If there is no microscopy, use 81002 ( non-automated, without microscopy). You must have a Clinical Laboratory Improvement Act license to use these codes, even if only waived status.

Regarding the copayment, the answer depends on the payer. Most require copayments for E/M services. Some require a co-pay for the procedure only, some only on an E/M service, and some on any and all codes. Consequently, you should ask the carrier for its policy.