Wiki Coding for Urinalysis with an Office Visit

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Carroll1220

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Good afternoon,

I sent a claim in to Medicare for a patient who had a Urinalysis done in the office by the provider the same day as they had an office visit. On the claim I submitted a CPT code as 81015-Urinalysis, bacteriuria screen microscopi only and put the charge next to it and on the second line I billed a 99212 for the Office Visit with a Modifer 25. I did not put a charge next to this because the E&M was done the same day. Medicare sent it back saying that there were errors in billing. Would someone please be able to send some light on the subject? Should I just not include the 99212 E&M portion and only bill for the urinalysis?

I would really appreciate feedback on this as I do not have any coders in the office to ask about this.

Thank you so much for your help!
Noelle
 
Hi Noelle,

I'm sorry, I'm a bit confused as to why you wouldn't charge the 99212 if the patient was indeed seen and treated by the physician for the problem? I wouldn't use a 25 modifier in this instance. Was the urinalysis ordered by a different provider? Also, I'd look at your other u/a codes. CPT 81015 is for microscopic analysis. Typically, I see 81000 or 81002. Please let me know if I misread something.

Lena
 
Hi, Lena!

Thank you so much for your response! The physician did the urinalysis himself in his office with a microscope and they bill a flat rate for the service. When I submitted the CMS 1500 form, I put the charge with the urinalysis code and then on the next line, put the E&M code 99212 with a modifier 25 next to it and did not put an amount because I had put the charge to the urinalysis code.

Would the urinalysis code be bundled in with the 99212 code? Or should I find out from the provider the charge of the urinalysis code and bill each separately with their respective costs? I appreciate your assistance with this!

Thank you for your help!
Noelle
 
You will need to bill out an amount on each charge line. Does your office use a universal charge master? Some offices have their billed amounts set as 30%above the MEdicare fee schedule amount for your locality. The accountant would be able to advise. Does your office have a practice manager? He/She would be the one responsible typically for this. What type of specialty is your provider?
 
Carroll1220 said:
Hi, Lena!

Thank you so much for your response! The physician did the urinalysis himself in his office with a microscope and they bill a flat rate for the service. When I submitted the CMS 1500 form, I put the charge with the urinalysis code and then on the next line, put the E&M code 99212 with a modifier 25 next to it and did not put an amount because I had put the charge to the urinalysis code.

Would the urinalysis code be bundled in with the 99212 code? Or should I find out from the provider the charge of the urinalysis code and bill each separately with their respective costs? I appreciate your assistance with this!

Thank you for your help!
Noelle
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Hey Noelle,

I'm in agreement with Teresa. Each line item should have a separate charge. Example:

99212 $75.00
81015 $15.00

Total claim amount: $90.00

Also, I don't see where a modifier 25 is necessary.

Hope this helps!
Lena
 
QW

Modifier 25 is not needed. What they payer wants to know, is if your office meets the criteria for Clia Waved Labs and has a Clia Certificate on file. If your office has Clia Certificate, you would bill the UA with QW modifier.
 
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