Wiki 80100 and 80101

[rphilpot]

A physician has asked me if she does a urine drug screen for multiple classes (80100), and it comes back positive so she additionally orders a urine drug screen for a single class (80101 - with x number of units dependent on the number of single classes tested), if she can bill both. So a claim would look like: 80100x1 and 80101x3. I am getting a CCI rejection without a modifer, but am unsure if it is appropriate to bill both. Or, if once the 80101x3 is done, it is expected to eat the cost of the 80100. Please advise.

 

[brockorama01]

You should only bill for one qualitative test. Qualitative test kits test 5 to 12 different classes with separate results for each. There is no need to run another qualitative test for a specific drug.

In the new regime, your doctor would bill for an 80104, one unit. If you are moderately complex, you can bill 80101 x # of classes to commercial carriers. Medicare is G0434, one unit.

Brock Berta, CPC