Get Paid for Tests and Test Supplies
Published on Sat Jan 01, 2000
Tying the test supplies purchased by practices to arguments for medical necessity and specific ICD-9 diagnoses can help increase pay-up, advises Kathy Palmerton, CPC, practice management consultant with the Healthcare Services Group in the accounting firm of Gordon, Odom and Davis in Sacramento, Calif.
But more often you can expect your carriers to follow Medicares lead and consider supplies as part of the expense of tests.
Generally, if an insurance carrier uses the relative value unit system (RBRVS) to determine reimbursement, supplies for most procedures will be included in their payment, explains Susan Callaway-Stradley, CPC, CCSP, an independent billing consultant in North Augusta, S.C. For example, if the urologist performs a renal biopsy (50200), the $9 needle used is no longer billable separately. Callaway-Stradley advises coders to determine whether the commercial carriers they use employ the RBRVS approach before submitting bills.
However, Palmerton says solid documentation of medical necessitytying the tests to a specific ICD-9 diagnostic code, can get tests reimbursedparticularly on appeal if you write a letter explaining this is the kind of office we have, this is the service provided, and we feel it should be paid, she says.
Urinalysis, skin test for collagen implant, urodynamics and biofeedback tests are examples of how medical necessity and documentation are crucial to getting payed.
1. Urinalysis. Urology offices also often experience problems receiving reimbursement separately for a dipstick urinalysis (81002, urinalysis non-automated, without microscopy). Many carriers and private payers consider the urine dip a part of evaluation and management (E/M) services (99201-99499), Palmerton says. But CPT considers the test to be a separate procedure. If a practice does a significant number of these tests and has documentation supporting the services provided, Palmerton believes a reimbursement denial can be appealed successfully.
Codes for Reporting Urinalysis:
81000Urinalysis 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
81002Without microscopy, non-automated
81003Without microscopy, automated
81005Urinalysis; qualitative or semi quantitative;
except immunoassays
81007Bacteriuria screen, by non-culture technique,
vommercial kit (specify type)
81015Microscopic only
2. Skin Test for Collagen Implant. The skin test for collagen implant for incontinence, which is frequently administered by urology practices, generally may be billed using only code G0025 (collagen skin test kit) says Palmerton. Not only do Medicare and many carriers disallow separate billing for the test itself and its administration [...]
