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  #1  
Old 10-04-2008, 04:53 PM
shellj shellj is offline
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Question 81002, 85610,

Please help,

Medicare has not paid any of our 81002, 85610 services, they paid the E/M = 99214, 99213 or 99215's. Can anyone tell me why?
The Dx I used for 81002' s = UTI's, or hematuria's
PT/INR's = 427.31
Thank you.
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Old 10-05-2008, 12:49 PM
lavanyamohan lavanyamohan is offline
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Quote:
Originally Posted by shellj View Post
Please help,

Medicare has not paid any of our 81002, 85610 services, they paid the E/M = 99214, 99213 or 99215's. Can anyone tell me why?
The Dx I used for 81002' s = UTI's, or hematuria's
PT/INR's = 427.31
Thank you.
Hi,
Medicare does not pay for urine dip-81002
Medicare pays for urine dip plus microscopy-81000
Only for ketones -without microscopy done-but rare- can give in the case of
diabetes patients -type II
Medicare will probably pay for lab tests related to diabetic care if those tests are supported by a diagnosis code(s) indicating diabetes and/or a pertinent symptom.
Urine albumin and microalbumin. Select from the following CPT codes as appropriate:
81000: Urinalysis, by dip stick or reagent tablet for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, PH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy
81002: Non-automated, with microscopy

CPT 99211 is used to report a low level E/M service. If this E/M code is billed along with CPT code (85610), the medical record must demonstrate that the E/M service was performed and was medically necessary. The medical report should identify significant new symptoms for which the patient needed to be seen.

Usually, hypertension can support better medical necessity for prothrombin- time.
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Old 10-06-2008, 01:25 PM
safnlp safnlp is offline
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There is nothing wrong with the dx you are using Is the lab doing the PT there are you sending it out? What does the EOB state on denial ?
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Old 10-06-2008, 02:54 PM
camcpc camcpc is offline
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Hard to say without knowing what the exact denial reason is, but it could have something to do with a CLIA? The CLIA number has to be associated with the CPT code for our carrier to pay any labs.
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Old 10-07-2008, 01:00 AM
Kumaran Kumaran is offline
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Cool

Medicare will pay for PT/INR 85610 if the diagnosis does support the procedure code. We need to check the LMRP,modifier(QW). Could you please send me the denial reason?

Medicare does not pay for 81000 and pay for 81002.Could you please tell me in which state you are billing?

Thanks
Vallikumaran B.P.T.,CPC.

Last edited by Kumaran; 02-24-2009 at 10:52 PM.
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Old 08-31-2009, 10:11 AM
brandylou brandylou is offline
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Is there a modifer besides qw that i need to be putting 81000...my medicare is not paying...i need help.. Does anyone know the answer?
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Old 08-31-2009, 07:18 PM
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rthames052006 rthames052006 is offline
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Quote:
Originally Posted by brandylou View Post
Is there a modifer besides qw that i need to be putting 81000...my medicare is not paying...i need help.. Does anyone know the answer?
Without knowing your denial reason from Medicare it's hard to say what the problem/issue is. I suggest you contact Medicare to find out exactly why they are denying your claim. Once you get that denial reason ( if it is not listed on the eob) then you can figure out your next move or have us help you.
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Old 08-31-2009, 07:19 PM
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Quote:
Originally Posted by lavanyamohan View Post
Hi,
Medicare does not pay for urine dip-81002
Medicare pays for urine dip plus microscopy-81000
Only for ketones -without microscopy done-but rare- can give in the case of
diabetes patients -type II
Medicare will probably pay for lab tests related to diabetic care if those tests are supported by a diagnosis code(s) indicating diabetes and/or a pertinent symptom.
Urine albumin and microalbumin. Select from the following CPT codes as appropriate:
81000: Urinalysis, by dip stick or reagent tablet for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, PH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy
81002: Non-automated, with microscopy

CPT 99211 is used to report a low level E/M service. If this E/M code is billed along with CPT code (85610), the medical record must demonstrate that the E/M service was performed and was medically necessary. The medical report should identify significant new symptoms for which the patient needed to be seen.

Usually, hypertension can support better medical necessity for prothrombin- time.

In regards to Medicare not paying for 81002 I have never had an issue with them paying for that. Who is your Medicare carrier? I have had experience with them not paying for 81002 and 81000 done on the same day.

In regards to HTN "better" supporting medical necessity for Pro-time. Does this patient even have HTN?
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Last edited by rthames052006; 08-31-2009 at 07:23 PM.
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Old 09-16-2009, 02:33 PM
babesjano babesjano is offline
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Re PT's depending on why the Dr is requesting this test. With the Dx you used I assume they are on anti coag meds. We use v58.83 as primary dx and e934.2 as the 2nd dx
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Old 09-24-2009, 06:46 PM
jsa1517 jsa1517 is offline
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Quote:
Originally Posted by shellj View Post
Please help,

Medicare has not paid any of our 81002, 85610 services, they paid the E/M = 99214, 99213 or 99215's. Can anyone tell me why?
The Dx I used for 81002' s = UTI's, or hematuria's
PT/INR's = 427.31
Thank you.
for the 85610QW we have recently noticed that with dx 427.31 (A-fib) they are not paying, we have started using dx V58.61 coumadin therapy for this.. we are tracking the most recent that we have billed with this instance to see what and if it pays, I can let you know..

The 81002 & 81000 on the other hand, they both rarely pay, if anything it isn't much. We do use UTI for a dx alot and also hematuria too as you said, I will look into this when I get to the office tomorrow, to see if I can see what our reimbursement is. Just good to know anyways too!
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