Forum - Questions & Answers

Dec 9th, 2015 - padi1coder 10 

Medicare denied 81002 with OV

Does Medicare not pay for a urinalysis done in office? I have tried with modifier 25 on the ov and a QW on the 81002, I am also getting denials for commercial ins.

Dec 9th, 2015 - alpjeffrey 14 

re: Medicare denied 81002 with OV

We usually don't have a problem with a UA getting paid. However, we usually bill either 81001 or 81003. Will you post what you billed and also what denial you actually received from Medicare?

Dec 16th, 2015 - padi1coder 10 

re: Medicare denied 81002 with OV

99214 -25

DENIED-(CO4 ) - The procedure code is inconsistent with the modifier used or a required modifier is missing.

Dec 16th, 2015 - alpjeffrey 14 

re: Medicare denied 81002 with OV

So, just a guess...but maybe it has to do with the CLIA cert "level". Our office, for instance, is allowed to do certain blood tests and UA because of our CLIA level and the fact that we are Urology specialty. Whereas, the primary care doctors in our area have a totally different level of CLIA cert because of all the different types of testing they do on a daily basis. That's the only thing I can come up with. With it saying it doesn't like the modifier, it has to be the QW because the 25 is correct.

Have you had it deny before without the QW?

Dec 16th, 2015 - Billingexperts 7 

re: Medicare denied 81002 with OV

Modifier 59 to 81002. More importantly check your pointers. Point the 81002 specifically only to the dx codes related to the related dx to 81002.

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