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E&M and urinalysis codes

  1. Default E&M and urinalysis codes
    Medical Coding Books
    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.

  2. Default
    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.

  3. Default 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.

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