Urology Coding Alert

Stand up for payment if carrier bundles urine dip into E/M

Urinary tract infection (UTI) is the most common condition treated by pediatric urologists, according to the Web site urologychannel.com. The treatment by antibiotics is relatively straightforward - but coding for the follow-up urinalysis can sometimes be cloudy. If the analysis shows that the infection has cleared up, which diagnosis code should you use?
 
The best code may be the same diagnosis as for the first visit, such as 599.0 (Urinary tract infection, site not specified), says Tracy Shambley, insurance coordinator for Camden Urology Clinic in Camden, Ark. Once a diagnosis has been made, you can use it for all of the treatment connected with the condition, until the treatment is completed. The follow-up urinalysis is to assess the disease process and determine the presence or absence of an infection - it can be considered part of the UTI treatment. Code 599.0, Shambley says, most closely represents the reason your urology practice is seeing the patient: the UTI.
 
Alternative: Other experts advocate using V codes for the follow-up urinalysis, ICD-9 V67.59 (Other follow-up exam) or V67.9 (Unspecified follow-up exam). However, some Medicare and many private insurers will not recognize a V code as establishing medical necessity for a procedure, and thus will not pay for the service.
 
Don't miss: Beyond the diagnosis code, remember that you must do more than a urinalysis to bill an E/M service for this visit, Shambley says. You must document a chief complaint, take a history and have an assessment plan, even if you are only billing a nurse's visit (99211).
 
Pitfall: Urology offices also often have problems receiving reimbursement separately for a urinalysis (81000-81003, 81005-81020). Many carriers and private payers consider the urine dip a part of E/M services, but CPT Codes considers the test to be a separate procedure.
 
Fight back: The American Urological Association (AUA) offers an appeal letter for urinalysis denials. Call the association at 1-866-RING AUA (1-866-746-4282) or visit www.auanet.org.