tci E/M Coding Alert - 2015 Issue 10

Reader Question: Try 25 for E/M + Urinalysis

Question: Our practice performs urinalysis (81003) for some patients and we are having trouble getting paid for both the urinalysis and the E/M service. Are these codes bundled? Maine Subscriber Answer: While the Correct Coding Initiative (CCI) doesn’t bundle these codes, unfortunately, many payers won’t reimburse you for both services. For instance, Horizon Blue Cross Blue Shield of NJ has a policy stating, “Urinalysis procedures (81002 or 81003) when billed in conjunction with any E/M service will not be separately reimbursed when a modifier 25 is appended to the E/M service or a modifier 59 (Distinct...

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