Wiki 81003 and E/M same day

[KATHY WILHELMSEN]

We are getting denials for the U/A done same day as a visit. They state either bundled, or included in payment of another service same day. These are private Ins. not MDCD or MDCR. Should we be using a 25 on the OV?

 

[Leandra]

We've never used a 25 when billing a lab with an E & M; what is the diagnosis that warrants the UA?

 

[ttcoding]

we have a couple of ins company that we had to add 25 to E&M to get the ua paid

 

[KATHY WILHELMSEN]

hematuria
dysuria
incontinence
a number of things, it is not done routinely on every patient

 

[KATHY WILHELMSEN]

So, adding a 25 to the E/M is okay to do to get the U/A and the E/M paid?

 

[zaidaaquino]

Yes. Some insurances' guidelines require the use of modifier -25 on an E&M (especially for a level 4 and 5 E&M) in order to process urine charges.

Zaida Aquino