Wiki E&M and urinalysis codes

[reneedanielle22]

I have had a problem with Medicare saying claims aren't covered with e&m codes with urinalysis codes 81003,QW and 82570,QW. They are supposed to be covered at our practice so I'm not sure why we have gotten quite a few denials.

For example: 99213,25 51798 81003,QW 82570,QW

These codes keep kicking back with not covered but they are. Am I suppose to attach the Labs with it? When I attached the lab report I got it paid. But there is someone in the office questioning why I am attaching labs to the urines when they never did that before. If anyone has had this problem please let me know.

 

[trinalankford]

Are you sure that is the reason for the denial? We are paid for 81000 urinalysis (the only one we do in-office) and E/M codes. We are starting to notice Medicare denials for 81000 and E/M but for the reason of "no medical necessity." This is especially true in the case of prostate CA or elevated PSA. Those are being denied.

 

[emcee101]

Modifier 25 Usage

Since 51798, 81003 and 82570 all carry a XXX global status (global period does not apply), it could be kicking back because you're using a 25 modifier when it probably is not needed. I see no other reason why it would be denied.