Pathology/Lab Coding Alert

Question: Our lab performs an immunoassay drug screen for six drug classes for a Medicare beneficiary, and we have CLIA certification for high-complexity tests. Should we bill G0431?Louisiana SubscriberAnswer: The correct code depends on the complexity of the test you perform, not on your CLIA certification level (assuming you're approved for the level and type of test you perform). Immunoassay drug screens can be moderate or high complexity, depending on the manufacturer and/or instrumentation. For the work you describe for Medicare coverage, you should report one of the following codes depending on the complexity of the test:G0431 -- Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounterG0434 -- Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounterWatch reimbursement: You don't want to make n $82 mistake by billing a high-complexity test [...]