Linda Posted Tue 28th of August, 2012 13:46:07 PM
Our doctors billed cpt codes 87086, 81001 and 81002, both 87086 and 81001 were paid, but 81002 was denied as unbundled. Is it correct coding to use a modifier 59 with cpt code 81002?
SuperCoder Answered Tue 28th of August, 2012 16:04:16 PM
Code 81002 is granted waived status under the Clinical Laboratory Improvement Amendments (CLIA). If a CLIA-waived lab performs the test, it must be reported with modifier -QW (CLIA-waived test) to be reimbursed.
Do not fragment the service and report it with multiple codes if a single code describes the service. For example, if the lab carries out a nonautomated dipstick urinalysis with microscopic evaluation, report one unit of 81000, not 81002 plus 81015 (urinalysis; microscopic only). CCI edits do not allow the various urinalysis codes to be reported together because they represent different methods of doing the same test.
Routine chemical urinalysis is included in certain patient encounters, such as antepartum care. When any of the urinalysis tests 81000-81003 are carried out in such settings, the test is not separately reportable.