Wiki 81002 denials.....

[nneecole44]

I have searched and searched. We are getting denials on the 81002 when billed with 99213 saying it is integral to another service. In my research I have discovered a few thing things. Some say to add -25 to the office visit to get paid. Some say add QW. Some say the 81002 is bundled into the office visit. Any thoughts? Thank you.

 

[danachock]

Hi, nneecole
What are your claims actually being denied for? Is your facility CLIA certified for the proper application of the QW modifier? Is this possibly DOT related?
I do apologize, but I'm trying to discover helping you with your woes here.
Dana Chock, CPC, CANPC, CPNC, CPMA, CPB, RHIT

​

 

[nneecole44]

Thank you for your response. The denial says it is apart of another service billed with it. Which is the 99213. We are a family practice clinic with a clia certified moderate complexity. I thought the 81002 did not require the QW. We did try sending a claim back through with QW and it was denied too. I am just surprised that a urine dip would not be reimbursed separately. We buy and pay for materials to run the dip. Pay an employee to run the test. We usually always bill the 81000. Just recently our lab hasn't had someone to run the mircoscope so we are doing dips for now.

 

[amyjph]

You have to check with the specific payer to see if they consider it included. 81002 doesn't require a QW.
Are other payers denying as bundled or just that one? I bet they might have something in their policies that says it is. Either that or maybe the payer's edits are in error. You want to go back and look at when this started, how many, and if it's only one specific plan or not.