L29302

 

URINALYSIS

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Medicare will consider a urinalysis study medically reasonable and necessary for the following conditions:

• Clinical symptomatology which may indicate a urinary system condition such as:

o Urgency.

o frequency

o Dysuria.

o Flank pain.

o Suprapubic discomfort.

o Hematuria.

o Fever of unknown origin.

o Chills.

o Swelling in the periorbital.

o Abdominal and pedal areas of the body.

o Heavy foaming urine, etc.

Or

• Physical examination reveals distended bladder with associated symptoms listed above.

Or

• Patients on medications that are nephrotoxic (e.g., aminoglycosides).

Or

• Evaluation of patient’s response to treatment, such as antibiotic therapy for a UTI.

Or

• Conditions in which a urinalysis may be medically necessary are not limited to the following:

o Urinary tract infection.

o Glomerulonephritis.

o Kidney stone.

o Interstitial nephritis.

o Nephrotic syndrome.

o Acute renal failure.

o Polynephritis.

o Diabetic neuropathy.

o Polycystic kidney disease.

o Hyperplasia of prostate.

o Rheumatoid arthritis.

o Renoparenchymal hypertension.

o Even though a patient has a condition stated above, it is not expected that a urinalysis be performed frequently for stable chronic symptoms that are associated with that disease.

 

Documentation Requirements

• Medical record documentation maintained by the ordering/referring physician/nonphysician practitioner must indicate the medical necessity for performing the test including:

o Office/progress notes.

o Laboratory results.

• If the provider of the service is other than the ordering/referring physician/nonphysician practitioner, the provider of the service must maintain documentation of test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies.

o The physician/nonphysician practitioner must state the clinical indication/medical necessity for the study in his order for the test.

 

CPT/HCPCS Codes

 

81000 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITH MICROSCOPY

81001 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITH MICROSCOPY

81002 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITHOUT MICROSCOPY

81003 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITHOUT MICROSCOPY

 

 

Treatment Logic

• Urinalysis is one of the most useful indicators of health and disease, and is especially helpful in the detection of renal or metabolic disorders.

• It aids in diagnosing and following the course of treatment in diseases of the kidney and urinary system and in detecting disorders in other parts of the body such as metabolic or endocrinologic abnormalities in which the kidneys function normally.

• The components of a urinalysis include an evaluation of physical characteristics (color, odor, and opacity); determination of specific gravity and pH; detection and measurement of protein, glucose, and ketone bodies; and examination of sediment for blood cells, casts, and crystals.

• Some laboratories include screening for leukocyte esterase and nitrate and do not perform a microscopic examination unless one of the chemical screening (macroscopic) tests is abnormal or unless a specific request for microscopic examination is made.

• Diagnostic laboratory methods include visual examination; reagent strip screening; refractometry for specific gravity; and microscopic inspection of centrifuged sediment.

• Urinalysis can be performed either by automated instruments or the use of tablets, tapes or dipsticks.

• Dipsticks are chemically impregnated reagent (reactive) strips that allow for quick determination of pH, protein, glucose, ketones, bilirubin, hemoglobin, nitrate, leukocyte esterase, and urobilinogen.

• The tip of the dipstick is impregnated with chemicals that react with specific substances in the urine to produce colored end products.

• Color standards are provided against which the actual color can be compared.

• The reaction rates of the impregnated chemicals are standard for each dipstick, and color changes must be matched at the correct time after each stick is dipped into the urine specimen.

• Normally, the color is straw to dark yellow, specific gravity 1.005-1.035, pH 4.5-8.0, normal urobilinogen, and negative for protein, glucose, ketones, bilirubin, hemoglobin, erythrocytes (RBCs), Nitrite (bacteria), and leukocytes (WBCs).

Sources of Information and Basis for Decision

 

FCSO LCD 29302, Urinalysis, 02/02/2009. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Fischbach, F. (2003). A manual of laboratory and diagnostic tests (7th ed.). Philadelphia: Lippincott Williams & Wilkins.

 

Handrigan, M., Thompson, I., Foster, M. (2001). Genitourinary emergencies. Emergency Medicine Clinics of North America, Article 11952253. Retrieved July 20, 2004, from http://www.mdconsult.com.

 

Henry, J.B. (2001). Clinical diagnosis and management by laboratory methods (20th ed.). Philadelphia: W.B. Saunders.

 

Jacobs, D.S., Demott, W.R., Oxley, D.K. (2001). Laboratory test handbook (5th ed.). Ohio: Lexi-Comp Inc.

 

Palmer, B. (2004). Approach to the patient with renal disease. ACP Medicine. Article 480448. Retrieved July 20, 2004, from http://www.medscape.com.

 

The National Heart, Lung, and Blood Institute. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Retrieved July 20, 2004, from http://home.mdconsult.com.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply.

 

CMS LCD L29302 URINALYSIS