When it comes to urinalysis, should our order forms include with and/or without reflex?


Urine cultures are sometimes reflexed “when indicated” by abnormal results on the urinalysis. While this is good medical practice, it can be a sticky situation with compliance. Ensure that physicians have the option to select urinalysis either with or without reflex. Another safe practice is to disclose all reflex-test components with your annual physician acknowledgments of custom panels. In order for Medicare coverage to be provided for urinalysis, the patient must have signs or symptoms of a disorder or a condition that is known to affect the kidney/urinary tract. Protocols are not accepted by Medicare as orders. The additional diagnosis for coverage of the urine culture must come from the ordering physician and not assumed by the laboratory based on test results.

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.


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.