Revenue Cycle

Scenario: Lab test coverage

Medicare Update for CAHs, June 27, 2012

A physician ordered a bacterial urine culture (87086) for a Medicare patient from the hospital’s lab. The physician indicated that the test was ordered because the patient had a family history of urinary tract cancer (V16.59).

Will Medicare cover this test based on the ordering diagnosis?

No. Code 87086 is covered by lab NCD #1 (Culture Bacterial, Urine). A diagnosis of V16.59 is a non-covered diagnosis for all NCD edits. <Lab NCD Manual>

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