Wiki BCG and urine culture billing

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nomie7

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I was hoping someone could help me with the following coding situation. Our office does BCG instillations. It is protocol to have the patient come into the office a week before the scheduled BCG instillation, and submit a urine specimen to be sent to an outside lab for culture. When we are sending orders for Medicare patients, we have run into the problem of non-coverage on the lab charge for the urine culture as it was sent with a non-covered diagnosis code on the order. The order will have been sent with 188.9. I have copied and paste below what the chart note looks like for one of these such encounters. The patient will have previously been diagnosed with a Medicare covered diagnosis codes such as 788.63, 788.43, or 599.72; but that is not documented on this particular DOS. Does anyone have any thoughts of what diagnosis code should be billed that is covered? Is this service just not covered? I have considered V58.69 that is on the Medicare NCD list.

"Nursing Intake
Vital Signs
Ht: 68 in.
Comments: _________ came in today to drop off a urine specimen prior to BCG treatment. Urine was sent to Legacy for culture.


Urinalysis-Macro:
Glucose(mg/dl):Neg Normal: Negative
Bilirubin:Neg Normal: Negative
Ketones:Neg Normal: Negative
Specific Gravity:1.025 Normal:1.000-1.030
Blood:Neg Normal:Negative
pH:6.0 Normal:4.5-8.0
Protein:Neg Normal:Negative
Urobilinogen(mg/dl):0.2 Normal:<2.0
Nitrite:Neg Normal:Negative
Leukocytes:Neg Normal:Negative


Plan
New Orders:
Urinalysis [CPT-81003]
Specimen handling fee [CPT-99000]
CULTURE-URINE [PHS91580/654523]




PLAN:
His urine will be sent for culture and sensitivity. If it is negative, he will proceed with his next BCG."
 
Yes, 99000 is a non-covered service by medicare. Looks like it hasn't been covered since 2000?
 
I was looking for an ICD-9 to be put on the order for the urine culture (87088).
 
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