demery
New
When a provider orders a urine culture and sensitivity (C&S), I have typically credited it as one order. However, recently, a provider challenged this approach, arguing that they should receive credit for two orders. They referenced the guidelines and MDM grid, which state that providers can receive credit for "ordering each unique test." Since a unique test is defined by the CPT code set and the C&S has two billed CPT codes (87086 and 87088), the provider believes they should be credited for both.
My argument is that when providers order the C&S, they may not be aware whether one test or two will be conducted. If the culture result is negative, then sensitivity testing is unnecessary. On the other hand, providers argue that since the urinalysis (UA) is abnormal, the culture is likely to be positive most of the time, which is why they are requesting both tests.
I have looked for resources to support either argument, but have not found any so far.
My argument is that when providers order the C&S, they may not be aware whether one test or two will be conducted. If the culture result is negative, then sensitivity testing is unnecessary. On the other hand, providers argue that since the urinalysis (UA) is abnormal, the culture is likely to be positive most of the time, which is why they are requesting both tests.
I have looked for resources to support either argument, but have not found any so far.