Mrs. Lam was sent from her doctor's office to the outpatient laboratory for a urinalysis. Her insurance company denied the claim, stating that the procedure was not necessary. The healthcare professional reviewed the claim and saw that a urinalysis was ordered, and the diagnosis listed on the encounter form was upper respiratory infection. Why was this claim denied?

What will be an ideal response?

This claim was denied because a diagnosis of upper respiratory infection would not show medical necessity for a lab test to be run on a urine sample. This demonstrates improper code linkage and a lack of medical necessity.