80307-90

marvelh

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Typically this wouldn't be reported with modifier 90 as the code description indicates any number of drug classes, any number of devices or procedures MUE is 1 unit of service. Modifier 90 is used to report a separate test, such as a separate specimen performed at a different time, not used to report testing of multiple drug classes on a single specimen.
 

Kelsey07

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80307

If a G0480- G0482 is billed with a 80307 then would mod 91 then need to be added? And if 80307 is billed with an office visit then what modifier needs to be used? I'm having issues with Aetna Better Health on processing and paying the 80307 we had QW attached but she told me that it needs a modifier that's just not the correct one.
 

CodingKing

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If a G0480- G0482 is billed with a 80307 then would mod 91 then need to be added? And if 80307 is billed with an office visit then what modifier needs to be used? I'm having issues with Aetna Better Health on processing and paying the 80307 we had QW attached but she told me that it needs a modifier that's just not the correct one.

No since its not a repeat lab. its 2 different types of lab tests. Must be CLIA certified lab to perform anything other than 80305.
 

Kelsey07

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It is ClIA Certified so technically 80307 wouldn't need a modifier then just the 80305?
 

karamac

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90 modifier

80307 describes a method of presumptive drug screening that will not meet the requirements of a CLIA Waived procedure/device- so no "QW" modifier. Double check your CLIA# on the claim to make sure there isn't an error as well...

80305, 80306, 80307 are codes that represent presumptive screening..
G0480-G0483 and the 80320-80375 (AMA Codes) represent definitive testing --

No modifier is needed when billing presumptive and definitive testing.. I would just ensure if you are a provider's office that the definitive drug testing codes are part of your contract, this can also be true of 80307 as some plans do not consider this test appropriate in the office setting because of the amount of fraud and abuse there has been.


Have you seen this publication by Aetna Better Health?
https://www.aetnabetterhealth.com/westvirginia/assets/pdf/providers/Winter2018-Provider-WV.pdf

Excerpt...
Examples of inappropriate urine drug testing and/or abuse of urine drug testing:
 The routine use of large, arbitrary test panels
 Ordering confirmatory tests instead of presumptive tests
Ordering confirmatory tests on presumptive screens that are positive for an expected substance (e.g.
suboxone present in a patient receiving suboxone therapy)

 Unnecessarily frequent drug testing without consideration for the drug’s window of detection
 Ordering daily urine drug screens
 Ordering weekly urine drug screens on patients that have been established in treatment and have routinely
been having expected urine drug screens results

 The confirmation and quantification of all presumptive positive and negative test results
 Ordering a confirmatory test for more substances than what tested positive in the presumptive test.
Ordering multiple drug screens on the same DOS (e.g. ordering 80305 and 80307 on the same day)
 Unbundling drug screens and billing each substance individually


Aetna's policy is pretty restrictive, especially in the substance abuse space. The modifier probably triggered the denial, but I would be cautious of the frequency of testing and the use of definitive testing without the proper documentation to support it.
 

karamac

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each medicare adminsitrative contractor has LCD's specific to controlled substance monitoring, refer to those documents. There are quite a few, and the ORDERING PROVIDER not the LAB appends those codes to the claim form as they are written by the provider on the requisition form. As a reminder, clinical laboratories should not be listing diagnosis codes on their requisition forms as it can be considered steering the ordering provider to a diagnostic code that can trigger payment.
 

Zeal

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Hello,
I ma new to this pathology. I would appreciate in advance for assistance.
I have a multiple questions on billing 80307 & G0483 on the same claim.
1.Can we code CPT 80307 & G0483 on the same claim together for any insurance on the same day?.
2. Is it require different DX to bill these codes together on same claim on same day?
I checked CMS LCD also on these but did not get it do we need same or different DX to bill them together..
3.Here the office collects the sample from the patient, it then goes to lab1, which is in the same building as the office where the patient is treating. They run the initial screen for the initial result. And then it goes for further LCMS testing, which is also in the same building, same lab, etc., to obtain the confirmation. These may not always be done on the same day, but they are always billed by the date that they were collected. So Please advise do we need to bill separately on different dates to make it both payable or is it ok to Just bill these codes with same DX on the same day.
4 .I did not see any edits, and so no modifier required for this.
 
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