tci Medicare Compliance & Reimbursement - 2012 Issue 24

Reader Question: Unnecessary Lab Test Probably Won't Be Payable

Question: We have a patient who did not have a urinalysis done at his previous well visit, but then needed it done for his basketball camp form. The patient did not have any problems or issues with urination, just needed it for his camp form records. What diagnosis code could we use to submit this service to his insurance company? If we use the well child diagnosis code, the insurance may not pay for the actual well visit diagnosis code when the patient needs it. Answer: Unfortunately, you will likely not be reimbursed by the insurance company for this...

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