Urology Coding Alert

Remember that separate E/M code is allowed.

No matter how commonplace a test your urologist performs might be, you should always make sure you can prove medical necessity and thus support the need for the service. In last month’s issue of Urology Coding Alert, our experts shared advice on how to correctly code for urinary tract infection. Now they give tips on a related topic: urinalysis.

Why it’s important: Frank Cohen, director of analytics and business intelligence at Doctors Management, shared about the CPT^® codes reported most often for each medical specialty during his Jan. 16 presentation, “Risk-based Auditing: New Tools and Techniques.” His averages, based on CMS data, showed that four of the top 10 urology codes reported in 2019 were related to urinalysis.

Those four codes were:

• 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)
• 81003 (… automated, without microscopy)

Watch the Diagnosis Details

There are literally hundreds of possible signs, symptoms, test results, and other situations that can cause your physician to order a urinalysis, which is part of what can make coding the claims a challenge. Pay close attention to the possibilities, especially since the 2020 edition of ICD-10-CM introduced several important changes.

Change 1: Old diagnosis code R82.8 (Abnormal findings on cytological and histological examination of urine) was deleted and replaced by two new options: R82.81 (Pyuria) and R82.89 (Other abnormal findings on cytological and histological examination of urine).

Change 2: The descriptor for diagnosis R82.993 was revised by a single letter, shifting from “Hyperuricoscuria” to “Hyperuricosuria.” The good news is that both terms mean that the patient has excessive amounts of uric acid in the urine. You will just want to use the new spelling, which corrects a spelling error from the 2019 ICD-10-CM code book.

“Anytime you’re selecting a diagnosis, you need to pay attention to even the smallest details,” says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. “Many of the mistakes I see when auditing a practice’s claims are because the coder wasn’t paying close enough attention to slight differences between code descriptors.”

Don’t Miss E/M Opportunities

It’s not uncommon for a claim with a urinalysis code such as 81000 to also include an office visit code such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient …).

Good news: Current National Correct Coding Initiative (NCCI) edits do not bundle 81000 (or the other common urinalysis codes listed above) with 99213 or other evaluation and management codes.

That means you can submit both codes on the claim, but you might still occasionally run into reimbursement obstacles. Some payers might expect you to report modifier 59 (Distinct procedural service) with 81000 before reimbursing for both codes during the same encounter. Check with the payer to see if this is the case and whether they expect particular documentation supporting the service.