Basics of CPT code for Urinalysis
Urinalysis is examination for urine for accessing or diagnosing various disease states like urinary tract infections, bleeding in the urinary system, or kidney or liver disease as well as diabetes, some diseases of the blood, and bladder stone. Microscopic examination helps to detect the presence of cells and other formed elements. Urinalysis methods used by diagnostic laboratories include visual examination, reagent strip screening, refractometry for specific gravity, and microscopic inspection of centrifuged sediment.
Hence, for different methods there are different CPT code for urinalysis. Different codes used for urinalysis like CPT code 81000-81003 are used for dip stick urinalysis. We will check all the procedures codes related to urinalysis or UA and their coding guidelines for proper reimbursement from the payers.
Description of CPT code for Urinalysis
A urinalysis is performed with dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms, such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested.
The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed.
Bilirubin is a byproduct of the breakdown of red blood cells by the liver.
Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine, which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation).
A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys’ ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope.
The urine sample is placed in a test tube and centrifuged. The sediment is resuspended.
A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria. CPT code 81000 is reported for a non-automated test with microscopy and CPT code 81001 is reported for an automated test with microscopy. CPT code 81002 is reported for a non-automated test without microscopy and CPT code 81003 is reported for an automated test without microscopy.
For Urine Culture
A bacterial urine culture is a laboratory procedure performed on a urine specimen to establish the probable etiology of a presumed urinary tract infection. It is common practice to do a urinalysis prior to a urine culture.
- 87086 – Culture, bacterial; quantitative colony count, urine
- 87088 – Culture, bacterial; with isolation and presumptive identification of each isolate, urine
CPT code 81000-81003 are used for dip stick urinalysis. A dipstick is a thin, plastic stick with strips of chemicals on it. It is placed in the urine to detect abnormalities. The chemical strips change color if certain substances are present or if their levels are above normal. A dipstick test checks for acidity (pH), protein, sugar, ketones, bilirubin, infection and blood in urine.
Procedure code 81002, 81003, 81005 or 81015 are component of the complete procedure code 8100 or 81001. Hence, while coding do not code the complete procedures codes with its component, the payers will not be pay for the component cpt codes because it get included into the complete procedures.
A microscopic exam of urine will help in finding white blood cells (leukocytes), red blood cells (Erythrocytes) or bacterial infection in the urine.
Medical necessity for urinalysis CPT codes
The medical necessity or ICD 10 codes should always fulfill for urinalysis procedure codes for proper payment from the payers. The common supporting diagnosis codes for urinalysis cpt codes are kidney/urinary tract disorder, such as dysuria, frequency, hesitancy, nocturia, urgency, flank pain, pelvic pain, abdominal pain, etc.
For Medicare below limitations for Urine tests CPT codes
- CPT 87086 may be used one time per encounter.
- Colony count restrictions on coverage of CPT 87088 do not apply as they may be highly variable according to syndrome or other clinical circumstances (for example, antecedent therapy, collection time, degree of hydration).
- CPT 87088, 87184, and 87186 may be used multiple times in association with or independent of 87086, as urinary tract infections may be polymicrobial.
- Testing for asymptomatic bacteriuria as part of a prenatal evaluation may be medically appropriate but is considered screening and, therefore, not covered by Medicare. The US Preventive Services Task Force has concluded that screening for asymptomatic bacteriuria outside of the narrow indication for pregnant women is generally not indicated. There are insufficient data to recommend screening in ambulatory elderly patients including those with diabetes. Testing may be clinically indicated on other grounds including likelihood of recurrence or potential adverse effects of antibiotics, but is considered screening in the absence of clinical or laboratory evidence of infection
Read also : Coding tips for CBC CPT code 85025 & 85027
Additional Code Information
PC/TC Indicator (26):9 = Not Applicable
Multiple Procedures (51):9 = Concept does not apply
Bilateral Surgery (50):9 = Concept does not apply
Physician Supervision:09 = Concept does not apply
Assistant Surgeon (80,82):9 = Concept does not apply
Co-Surgeons (62):9 = Concept does not apply
Team Surgery (66):9 = Concept does not apply
Diagnostic Imaging Family:99 = Concept does not apply
Points to remember for CPT code for Urinalysis
- CPT codes 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651 do not require a QW modifier to be recognized as a waived test. If the lab that performs the test operates under a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver, most urinalysis tests should be reported with modifier QW (CLIA waived test)
- If complete test code 81000 or 81001 has been previously reimbursed to the same provider, for the same patient and date of service, claims for component test codes 81002, 81003, 81005 or 81015 will be denied.
- Similarly, if code 81000 has been previously reimbursed to the same provider,for the same recipient and date of service, claims for code 81001 will be denied since a complete urinalysis has been reimbursed and vice versa.
- Coders need to check with payers while coding the different urinalysis codes together, since commercial payers usually follows reimbursement guidelines than medicare. For example, United Healthcare considers CPT codes 81000 and 81002 as included in the global antepartum or global obstetrical(OB) service when submitted with an OB diagnosis code in an office setting. The services in the global obstetrical package related to both vaginal and Caesarean delivery that will not be reimbursed separately when performed by the OB provider are: Pregnancy test (CPT codes 81025, 84702, 84703).
- UnitedHealthcare Community Plan reimburses for Urine Culture, Bacterial (CPT codes 87086 and 87088), when the claim indicates a code found on the list of approved diagnosis codes for this test. UnitedHealthcare Community Plan will not reimburse when the treatment rendered is without inclusion of one of the ICD-10-CM diagnostic codes being included on the claim accurately
reflecting the member’s condition.
Hope, all these information for CPT code for urinalysis procedures will surely boost your coding knowledge and improve you coding skills.
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