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.