81001/81003 with G0479/G0480

tlccovert

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I need clarification on the UA drug screen(G0479/G0480) and urinalysis (81001/81003). We are getting edits that the 81001/81003 needs modifier if documentation supports M/N. What types of things should we be looking for in the documentation to allow the use of modifier on the 81001/81003. It is typically the same specimen being used to run both tests. When reviewing the test results the Urinalysis with culture is fully being run. They aren't just doing ph, creatinine, nitrates that would be part of a validity test.

One I am currently looking at the UA was tested for leukocytes, esterase, protein, nitrite, blood, glucose, ketones, pH, specific gravity, bilirubin and urobilinogen. Are these tests all considered Validity tests???

I have found this from the NCCI manual

E. Drug Testing
Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed. The Internet-only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 16 (Laboratory Services), Section 10 (Background) indicates that a laboratory test is a covered benefit only if the test result is utilized for management of the beneficiary’s specific medical problem. Testing to confirm that a urine specimen is unadulterated is an internal control process that is not separately reportable.


Greatly appreciate any guidance provided.
 
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