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Wiki DNA testing and Interpretation

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paynecoder1

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Pharmacogenomic and toxicology , I am new to this and my provider is wanting to start doing this. They are stating that we can charge for interpretation of these test and get paid in addition to the E&M code. Can anyone share their knowledge of how to bill correctly for this.
Thanks!
 
From the sounds of it, these are not CLIA waived tests so the physician cant bill for them. It must be a Lab if the code does not qualify under CLIA waiver.
 
I'm sorry I need to be more clear. We are being told that we can bill for interpretation and report and Im not sure I agree so I wanted to talk with someone who has done this before. They are promoting doing the pharmo test and drug screen and saying you can bill for the interpretation of both and both test will be sent to lab, accept we will use cup in house to see immediate results. And they are also talking about multiple units depending on panels. I am just not feeling comfortable with answers Im getting. Thanks for your help.
 
Are they telling you that you can bill an interpretation and report for a clinical laboratory test, in other words, bill the lab with a 26 modifier for a code that does not have a professional component per the Medicare physician fee schedule? If that's what they're talking about, this is a somewhat controversial area. Medicare and most payers that follow Medicare guidelines would not make payment for that, but there have been some inroads made into this by physicians who have argued that they should be reimbursed for the work of a professional component for clinical laboratory services, and I've read that in some states the courts have sided with the physicians and required insurance companies to pay this. So there may be some limited opportunities to bill this and be paid for it by certain payers in certain locations, but I'm not sure I'd recommend going down that path, if that's what they're suggesting.

But if not, they may be referring to some other method of billing - are you able to provide any specific examples of codes or billing scenarios, or can they give you any guidelines or specifics as to what exactly they're speaking of?
 
Physicians can indeed bill G0452-26, but that code is for interpretation and report of molecular pathology tests (it was created to replace 83912-26 when that code was deleted). As I understand it, that would be for interpretation of the tests represented by the CPT code range 81170 through 81479. I don't think that code would be appropriate for interpretation of drug screens or toxicology lab reports.
 
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