EM Coding Alert

Question: Is 99214 payable if coded with 81001 when the place of service is 22? Is urinalysis part of office visit? I know if I use place of service 11 we get reimbursed for 99214 and separately for 81001.

New York Subscriber

Answer: The place of service doesn’t necessarily play into the reimbursement for the 81001 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy) unless the equipment to do the analysis (along with the provider) is not owned/leased by the practice.

Caveat: If the physician comes into a practice that has the personnel to support him and the equipment and testing strips already there, then the service is not billable in that location. Otherwise, it is billable.

Therefore, you should be able to report 81001 with 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity …) with either POS 22 (Outpatient hospital) or POS 11 (Office).

Remember: Effective Jan. 1, 2016, and implemented Jan. 4, 2016, you’ll have two updated POS codes to consider for outpatient services, as follows:

• POS 19 (Off Campus - Outpatient Hospital) — Descriptor: A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
• POS 22 (On Campus - Outpatient Hospital) — Descriptor: A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.