Question:

Does CMS provide a list of the conditions that it considers medically necessary for a urinalysis?

Answer:

There are many examples of when urinalysis is considered medically necessary by the Medicare Program. However, the best thing is to verify coverage of pre-operative testing with the individual payers. Most payers have reimbursement policies and list the tests that are non-covered when ordered as a screening procedure prior to surgery.

Also remember to document lab tests with signs and symptoms or ICD-10 information concerning the reason the test is being performed, not the post-test diagnosis. It is inappropriate for laboratory personnel to use post-test diagnosis for addition of reflex tests unless the treating physician has reviewed the initial result and provided in writing the additional diagnosis.


This question was answered in the 2018 edition of our Coding Essentials for Laboratories. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.

Facebook
Twitter
LinkedIn
Email
Print

CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.