Wiki 80307 & G0480/G0481/G0482 Denials

[leigh@lafayettepaincare.net]

I work for pain management who has an inside lab where we do urine drug screens and UDS confirmations. We have been having so many denials for these codes, and I'm not quite sure what the issue is. We usually will bill the OV 9924 25 modifier, 80307 usually with the Z79.899 code for the urine. Humana will not pay for any of the UDS/UDS confirmation, and a lot of the other payers are denying this as well. Unfortunately, we do not have a coder on staff to ask these kinds of questions so I am looking for any help you can offer. Should they be billed separately from the office visit? Thank you!

 

[andersona1229]

Hello! I worked for an independent laboratory that specializes in UDT, so I can probably help you with this. If you want to send me a message, I'll see what I can do.

 

[jkyles]

I work for pain management who has an inside lab where we do urine drug screens and UDS confirmations. We have been having so many denials for these codes, and I'm not quite sure what the issue is. We usually will bill the OV 9924 25 modifier, 80307 usually with the Z79.899 code for the urine. Humana will not pay for any of the UDS/UDS confirmation, and a lot of the other payers are denying this as well. Unfortunately, we do not have a coder on staff to ask these kinds of questions so I am looking for any help you can offer. Should they be billed separately from the office visit? Thank you!

Hi there, a couple of things:

1. What is your practice lab's CLIA certification, and is it up to date? If you suddenly started getting denials for 80307 it could be that your certification has expired. Or, it could be that payers have made the blanket decision that they aren't going to cover 80307 for practice labs.

2. Medicare and many private payers will only cover definitive drug testing code G0659 for medical practice labs. Medicare created it to describe the less complex equipment used in practice labs, compared to the G08## codes.

So far as the separate office visit is concerned, what's happening during the visit, and does it justify the highest level E/M visit for every encounter? The fact that the patient is on COT doesn't make every encounter high level.

I know you all don't have a coder on hand but this is why at the very least you should contract with a RCM company (preferably one with a lot of pain clinics on its client list) to help you out. Free advice on the internet can only take you so.

Billing for UDT has been a compliance hot spot for years and unfortunately that means pain practices' coding patterns get a lot more scruitiny by payers and investigators.

 

[leigh@lafayettepaincare.net]

Hi there, a couple of things:

1. What is your practice lab's CLIA certification, and is it up to date? If you suddenly started getting denials for 80307 it could be that your certification has expired. Or, it could be that payers have made the blanket decision that they aren't going to cover 80307 for practice labs.

2. Medicare and many private payers will only cover definitive drug testing code G0659 for medical practice labs. Medicare created it to describe the less complex equipment used in practice labs, compared to the G08## codes.

So far as the separate office visit is concerned, what's happening during the visit, and does it justify the highest level E/M visit for every encounter? The fact that the patient is on COT doesn't make every encounter high level.

I know you all don't have a coder on hand but this is why at the very least you should contract with a RCM company (preferably one with a lot of pain clinics on its client list) to help you out. Free advice on the internet can only take you so.

Billing for UDT has been a compliance hot spot for years and unfortunately that means pain practices' coding patterns get a lot more scruitiny by payers and investigators.

Hello, thank you very much for your response! I understand how free advice can only get us so far, I know we def need a coder on hand and we have been trying to convince the powers that be....but The Clia was my first thought as well, but we are up to date and the number is included on each doctor. I don't think its suddenly...we recently moved our billing to in house last July and I've only been here since Feb, so we are starting from the bottom. The doctors are the ones choosing the office visit codes, so I cannot speak to the accuracy. I've just been trying to work denials, and the doc is very concerned about the UDS denials specifically. I will look into the G0659 code usage. I truly appreciate your thorough response!