Pathology/Lab Coding Alert

Question: We know that Medicare is reviewing urine reflex cultures, and we're wondering if we can reflex to urine culture due to findings indicative of UTI: positive esterase, nitrite and WBC?Minnesota SubscriberAnswer: As you mentioned, reflexing to urine culture based on urinalysis findings is something Medicare is watching closely. That's why you need to ensure that the physician actually "orders" the reflex test based on specific findings.How you do it: You might establish laboratory protocols for results that reflex to the urine culture (87086, Culture, bacterial; quantitative colony count, urine) -- in your case, positive esterase, nitrite and white blood cells (WBC) found on initial urinalysis that the physician orders (such as 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). Then, you need to ensure that the physician order includes the [...]