Pathology/Lab Coding Alert

Question: A physician client routinely sends our lab orders for "screening" urinalysis for Medicare patients as part of an annual wellness visit, but we get denials for the test. What is the coverage problem, and how can we resolve it?Indiana SubscriberAnswer: Medicare does not pay for a screening urinalysis assay, so that's the coverage problem. Medicare urinalysis coverage depends upon the patient having signs or symptoms supporting medical necessity (such as burning during urination).If you routinely receive screening urinalysis requests as part of the ordering physician's annual wellness visits, ask the physician to obtain a signed at Advance Beneficiary Notice (ABN) from the patient beforehand to cover the screening urinalysis.Better: If the physician discovers signs or symptoms that indicate the need for urinalysis, have the ordering physician indicate the symptoms on the requisition.For instance: Medicare payers typically cover urinalysis for the following situations (with a few covered ICD-9 code examples):Kidney/urinary [...]