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81003 bundling to office visits

  1. #1
    Exclamation 81003 bundling to office visits
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    Please help!!!

    We billed an office visit along with an ua (81003). The ins bundled the ua into the office visit. We are going to appeal this claim. I was wondering if anyone has had this issue with ua (81003) not getting paid?

    Has anyone added a -25 modifier on to the office visit?

  2. #2
    Charleston, WV
    Urinalysis is a readily available adjunctive component of a physical examination. It is considered an inherent component of an outpatient E&M service. The resources required for this examination are limited and should be included in the selection of the level of E&M service. Modifier 25 will not get the urinalysis paid. However, modifier 59 reported with 81003 will but be careful to only report it if the documentation supports the use of this modifier.
    J G Stanley, MHA, CPC

  3. #3
    Some insurances bundle a urinalysis when the level of the E&M is a level 4 or 5. Other insurances' guidelines would have you add modifier -25 to the E&M in order to have the urinalysis paid. So depending on the insurance company, the E&M with -25 will allow for the urine charge to be paid. You might want to take a look at your carrier's guidelines. Hope this helps.

    Zaida V Aquino, CPC

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