Question

question 1

what is the code and any required modifier(s) for dipstick urinalysis, non-automated, without microscopy performed in a physician office for a medicare patient?

81025-26-qw
81002-qw
81002
81002-26-qw

Explanation:

Identify the correct CPT code for the procedure

The procedure is a "dipstick urinalysis, non-automated, without microscopy."

• CPT code 81002 represents: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, therapeutic drug screening, each; non-automated, without microscopy.
• CPT code 81025 represents a urine pregnancy test, which is incorrect.

Determine the required modifier(s)

• The test is performed in a physician office laboratory (POL) for a Medicare patient.
• Non-automated dipstick urinalysis (81002) is a CLIA-waived test. For Medicare claims, CLIA-waived tests performed in a facility with a CLIA Certificate of Waiver require the modifier -QW (CLIA Waived Test).
• Modifier -26 (Professional Component) is not applicable because a dipstick urinalysis is a complete laboratory test that does not have separate professional and technical components in this setting.
• Therefore, the correct code and modifier combination is 81002-QW.

Answer:

• (A) 81025-26-QW
• (B) 81002-QW (Correct answer)
• (C) 81002
• (D) 81002-26-QW