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A urine test is conducted to assess the levels of vanillylmandelic acid (VMA), which is a significant metabolite derived from the catecholamine hormones, specifically epinephrine and norepinephrine. These hormones are produced by the adrenal glands and play crucial roles in the body's response to stress and regulation of various physiological functions. The measurement of VMA levels in urine is important as it can provide insights into the functioning of the adrenal glands and the presence of certain medical conditions. It is normal for VMA levels to exhibit small fluctuations; however, mildly elevated levels can occur due to various factors such as hypertension, anxiety, physical exercise, and the intake of certain over-the-counter (OTC) medications and herbal supplements. Significantly higher levels of VMA may indicate the presence of neuroendocrine tumors, including neuroblastoma or pheochromocytoma, which are conditions that require further investigation. This test is not only utilized for diagnosing these disorders but also for monitoring the effectiveness of ongoing treatment. To perform the test, either a 24-hour urine specimen or a random urine sample is collected and subsequently analyzed using quantitative high-performance liquid chromatography, a precise method that allows for accurate measurement of VMA levels.
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Vanillylmandelic acid (VMA) testing is indicated for various clinical scenarios, particularly when there is a suspicion of neuroendocrine tumors or other related disorders. The following conditions may warrant the performance of this test:
The procedure for obtaining a urine specimen for VMA testing involves several key steps to ensure accurate results. First, the healthcare provider will instruct the patient on how to collect the urine sample. This may involve a 24-hour urine collection, where the patient is required to collect all urine produced over a 24-hour period in a designated container. Alternatively, a random urine sample may be collected at a specific time. It is essential for the patient to follow any preparatory instructions provided by the healthcare provider, which may include dietary restrictions or avoiding certain medications that could affect VMA levels. Once the urine specimen is collected, it is sent to a laboratory for analysis. In the lab, the urine is subjected to quantitative high-performance liquid chromatography, a sophisticated technique that separates and quantifies the VMA present in the sample. This method allows for precise measurement of VMA levels, which are then reported back to the healthcare provider for interpretation and further clinical decision-making.
After the urine specimen has been collected and sent for analysis, there are generally no specific post-procedure care requirements for the patient. However, it is advisable for patients to maintain hydration and follow any additional instructions provided by their healthcare provider. Once the results of the VMA test are available, the healthcare provider will review the findings and discuss them with the patient. Depending on the results, further diagnostic testing or treatment may be necessary, especially if elevated VMA levels are detected, indicating potential underlying conditions such as neuroblastoma or pheochromocytoma. Continuous monitoring may also be recommended to assess the effectiveness of any ongoing treatment.
| Short Descr | ASSAY OF URINE VMA | Medium Descr | ASSAY OF VANILLYLMANDELIC ACID URINE | Long Descr | Vanillylmandelic acid (VMA), urine | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 233 - Laboratory - Chemistry and Hematology |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | GA | Waiver of liability statement issued as required by payer policy, individual case | Q4 | Service for ordering/referring physician qualifies as a service exemption |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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