Wiki 81003 qw

[jwolf13721]

Having issues from multiple carriers of bundling of this procedure code with the evaluation & management for same day. I have searched this site and multiple other sites for current policy on this. Is anyone else seeing this and what are your thoughts? I have appealed to Aetna, specifically, and they upheld their original denial. I have been told by Anthem they are using a processing tool called ClaimsXten (a McKesson product) and it is bundling. Any help would be appreciated.

Thanks!

 

[reneedanielle22]

yes i am having the same issues with medicare on this. 81003,QW and 82570,QW

 

[emcee101]

We ran into this too, and were having to use a 59 modifier to have it paid.

 

[careymvigor]

81003 IS SI payer issues

For me doing urine drug screens and adulterants and uas to authenticate the sg pH creatinine etc to rule out substitution and adulteration it has been hit or miss but for sure you have to use the code V58.69 with 304.01 for opiate addiction as well as the V23 code if pregnant and you suspect gestational diabetes or psychotropic drug induced diabetes etc in other words your ICDs must cross reference for IS and SI Psych patients might also have an E code for adverse effects of the therapeutic use of atypical antipsychotic drugs which commonly cause diabetes and glucosuria Anthem commercial pays a pittsnce but they do pay although posting copayments of sixty cents or 51 cents makes Anthem commercial a waste of time. Medicaid pays far more thsn that and wven Medicare pays better than Anthem commercial for any urine test that is low complexity CLIA waived