Wiki Urinalysis not covered by Medicare with E/M code

[Heather$]

Our office has recently credentialed with a lot of insurance companies and we are learning a lot about billing. Today we received a denial from Medicare for a Urinalysis (81002) due to "The code is inconsistent with the modifier used or a modifier is missing." We have billed with and without the QW modifier and both have been denied. We have read some people put modifier 25 on the E/M code, then others have said not to. Does anyone have any advice for us newbies? Thanks in advance!

 

[erjones147]

Just brainstorming here, but the problem may be with the device you are using vs. the code. Is your urinalysis device CLIA-waived or moderate complexity?

 

[Heather$]

CLIA Waived.

 

[erjones147]

Would 81003-QW be a better code for the device/test you are running?

 

[Heather$]

81003 is for automated tests and our test are not automated so I believe the CPT code is correct. Just seems like it should be covered.

 

[jhendrix08]

We use 81002 also and I don't bill a modifier with it. Actually, when I do add the modifier (if I'm not paying attention), our EHR system will flag it "inappropriate use of modifier with a lab procedure." I haven't had any trouble getting it reimbursed. Wish I could help more...I'm stumped as to what the issue is.