Wiki Urine culture denials

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linton@bresnan.net

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Our facility's lab dept has a protocol when a UA comes back abnormal a culture is automatically done. However since the coder does not code from lab results but the order itself the dx will pass for the UA but not the urine culture. We are considering a policy/protocol where the physician lab director has a standing order for urine cultures with an abnormal findings dx code. Any input from other coders or facilities regarding how to go about this or examples from other facilities would be so appreciated. Thanks for any and all help!

CML, CPC :)
 
linton@bresnan.net said:
Our facility's lab dept has a protocol when a UA comes back abnormal a culture is automatically done. However since the coder does not code from lab results but the order itself the dx will pass for the UA but not the urine culture. We are considering a policy/protocol where the physician lab director has a standing order for urine cultures with an abnormal findings dx code. Any input from other coders or facilities regarding how to go about this or examples from other facilities would be so appreciated. Thanks for any and all help!

CML, CPC :)
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Are these UAs diagnostic?

I have never come across a situation where an additional test is done based off abnormal results of the first test when no order exists to do the additional test. There has to be a medically necessary reason for the culture, which has to be documented, and such test would have to be ordered. I don't know that a standing order that applies across the board would satisfy the requirement of proving medical necessity as it really would be case-by-case specific. I think that automatically performing a culture for every abnormal UA might raise some red flags for potentially unjustified overuse.

Out of curiosity, if the order comes down with a "suspected" or "probable" diagnosis, is that what the coder is using for all charges, for both normal or abnormal results? If the UA results are abnormal, is the coder not including that when applying DX codes?
 
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