Wiki 2015 Drug Screen Coding

[beautifulthree@yahoo.com]

I have a question, our providers billed 80104 last year for commercial payers and G0434 for Medicare for a rapid urine drug screen. Our process will not change but our providers have started using 80303 as a replacement for 80104 I do not think this is a correct replacement code because they seem to be opposite.
80104 states "multiple drug classes OTHER THAN CHROMATOGRAPHIC METHOD"
80303 states "drug screen, any number of drug classes, presumptive, single or multiple drug class method; THIN LAYER CHROMATOGRAPHY PROCEDURES (TLC)"

I think the correct replacement code should be 80300

Any assistance would be greatly appreciated. Has anyone else received payment in 2015 with the use of the new drug screening codes?

 

[AC32333]

You are correct. See page 472 of the 2015 Professional Edition CPT Code Book:

"To report five (5) presumptive drug classes performed using a direct optical observation device procedure (drug test cup or five separate dipsticks), report 80300 once per date of service."

Medicare has advised in their Clinical Laboratory Fee Schedule (CLFS) Final Determinations that they will delay pricing of the new CPT codes for drug of abuse testing. The recommendation is to follow 2014 CMS guidance including the use of G0431, G0434 and 80102 as appropriate for drug screening. (See http://www.cms.gov/Medicare/Medicar...ds/CY2015-CLFS-Codes-Final-Determinations.pdf)