Urinalysis (with microscopy)

This is a urine test in which the chemical strip reading is followed by someone spinning the sample down and examining the sediment under a microscope. The microscopic step is what finds red cells, white cells, bacteria, crystals and casts, which the strip can only hint at.

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What it is

Urinalysis has two halves. The chemical half dips a strip with reagent pads into the sample and reads the color changes for things like protein, glucose, blood, ketones and signs of infection. The microscopic half, which is what this code adds, spins a portion of the urine in a centrifuge and puts the sediment under a lens. That is where the actual particles are counted: red blood cells, white blood cells, bacteria, crystals, and casts, which are molds of the kidney's own tubules. The strip can say blood is present; only the microscope can say whether the red cells arrived in clumps, alone, or wrapped in a cast pointing back at the kidney itself.

Why it is done

  • To confirm and characterize a urinary tract infection, by counting white cells and seeing bacteria rather than inferring them from a color change
  • To work out where blood in the urine is coming from, since casts and the appearance of the red cells distinguish a kidney source from a lower one
  • To look for crystals when kidney stones are suspected
  • To follow kidney disease, where the sediment findings carry information the chemical strip does not

What to expect

A urine sample is collected, usually as a clean catch midstream so that whatever is on the skin does not end up in the cup. The strip result is available within minutes. The microscopic exam requires a centrifuge and a person at a microscope, so it adds time, and in an outpatient setting it may mean the sample travels to a laboratory rather than being read in the room. A positive finding often leads to a urine culture, which is a separate test taking a day or more.

Questions worth asking

  • Was the microscopic exam ordered up front, or added automatically because the strip was abnormal? Reflex microscopy is a second charge nobody discussed.
  • Is this being billed with microscopy when only the strip was needed? The two are different codes at different prices.
  • If a urine culture followed, is it billed separately, and was it in network?
  • Was the sample examined in the clinic or sent out? A send-out adds a handling or transport charge at some practices.

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