Urology Coding Alert

Question: For all lab tests performed in the office, our nurse researches the history, collects the sample, then gets the results. Can I therefore bill 99211 with urinalysis code 81002?

Indiana Subscriber

Answer: No. CPT^® guidelines prohibit reporting 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional) with 81002 (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, without microscopy) in the outpatient setting, though no National Correct Coding Initiative (NCCI) edit exists for 81000-81003 (Urinalysis…) when the tests are Column 2, or component, codes for office/outpatient evaluation and management (E/M) services 99202-99215 (Office or other outpatient visit for the evaluation and management of a/an new/established patient …).

Remember: When you report 99211, there must be some “evaluation and management” of the patient by clinical staff. If the CPT^® code does not capture all the work the provider performs in the visit, you may be able to report 99211. The work described for the urinalysis is included in the urinalysis code. But you may be able to use 99211 for additional work, such as a periodic blood pressure check, according to Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager at MRO in Philadelphia

Obtaining patient history and getting results doesn’t count as a true E/M service. Billing an E/M service requires that the patient have an exam in which they discuss symptoms, and the physician performs medical decision making (MDM) considers possible diagnoses and makes a treatment plan.