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Urine specimen charges/hematocrit copay for rechecks?

Patti Posted Thu 14th of May, 2015 14:52:27 PM

1. If a patient can not give a urine specimen on the day of their physical exam, and comes in the next day, do they owe a copay and how do we bill for the urine screening to connect to the previous day's preventative physical exam?

2. Parents of patients who have a history of urinary problems, drops off urine specimen for the child, without the child present and with no visit or evaluation done. The reasons can be due to a child complaining of burning with urination, or a strong smell of the urine or just a worried parent for a urine dip to determine if there is a problem with the urine. Can we and should we charge a copay, even if the child was not present? What code would we bill for the urine? Should we just list the chief complaint, do a urine dip or micro and bill appropriately?

Should we make the urine screen a nurse visit and charge a 99211? Charge a copay? Is it ok to bill insurance and not have the child present and not do a visit or evaluation, just a lab test? If the result are abnormal, the physician would send out the urine for culture and call in an Rx for the child. Do we then charge if the results are abnormal only?
The physician become involved and the child is not present. How do we charge for the doctors time, they may need to make a referral? What evaluation and management codes do we use for the doctors time, child not present, it was a dropped off urine with a normal or abnormal finding?

Thank you in advance for your help.
When we do a hematocrit recheck on a different day from the physical exam, the child is present. We bill a nurse exam and a 99211 and should we collect a copay.

SuperCoder Answered Fri 15th of May, 2015 03:26:48 AM

1. Lab services performed will be included in the preventive services as it is considered a part of the procedure. E&M service can be billed if the problem is significant enough to require additional work up to perform the key components of a problem oriented E&M service, then the appropriate E&M code should also be reported.
2. To bill an E&M code it is important that an An E/M service has been provided. Generally, this means that the patient’s history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. For example, 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.

Would request you to use multiple threads for multiple queries.

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