Wiki DNA testing

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Cassandra Stone

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I have received mixed information about DNA testing done in office. Some of the reps said to use 81225-26, 81226-26, 81401-26 x2. Some of the people I've discussed this with argue you can't bill those codes because the lab will be billing them. I'm not sure about that logic because when we do a drug screen in office we bill a code from the pathology and labratory section of CPT, and I would imagine the lab does as well and we still get paid. Does anyone have any thoughts or information you could offer regarding DNA testing and coding for pain managaement doctors? Thank you very much!
 
I believe you are inquiring about salvia drug testing. I personally don't believe a test kit that is identifying drugs in a patient's saliva would meet the intention of the DNA lab codes.
 
It is actually DNA testing to identify how the patient metabolizes each drug. The doctors office takes the swab, sends it to the lab, and the physician uses this information to help with medication selection.
 
Collecting the specimen for an outside reference lab to perform the ordered diagnostic DNA testing would not be billed with the Molecular pathology testing codes. The office is only collecting the specimen, i.e. swabbing the inside of the patient's mouth, not performing the tests.

You may want to look at 99000 Handling and/or conveyance of specimen for transfer from the office to a laboratory, however many insurance payers don't allow coverage for this code.

In contrast, when the office collects and performs the qualitative drug screen testing, it is billable. The specimen may be sent on to the reference lab for confirmation / quantitative testing but not duplicative testing that was performed in the office.
 
In addition, the molecular pathology codes that were listed don't have separate professional and technical components and as such it would not be appropriate to append modifier 26 or TC to these codes.
 
Thank you very much for your input. For the physician's services (reviewing the results to help with medication management) would you bill with 99358 and 99080 for any reports? I just want to make sure the physician gets paid for his work, as he will be using this data to help with medication selection.
 
Cassandra Stone said:
Thank you very much for your input. For the physician's services (reviewing the results to help with medication management) would you bill with 99358 and 99080 for any reports? I just want to make sure the physician gets paid for his work, as he will be using this data to help with medication selection.
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We are using this same service. As far as I know, our providers are not billing anything extra to review the results of these DNA tests. I would think it would be one of the elements of "Data Reviewed" (like any other labs they review) at the patient's next visit. If extensive time is required for this review, can possibly bill that next visit based on time. However, 99358 could be a possibility, if they are spending that much time reviewing, before the patient returns for follow-up. But then there's the "which payers will pay that?" issue. 99358 is not on the 2013 Medicare fee schedule that I have downloaded from my MAC (Novitas).

Just a few points to consider; hope this helps! :)
 
Thanks for your input Megan! So does your office just bill G0452 and accept the $20 as payment in full for this service? Our physician wants to be paid not so much for the collection but for reviewing the results/using it to determine which medications to prescribe. This will be where his time is spent in regards to this procedure. Another problem I have is medical supply reps that go in and tell the Dr. he will be reimbursed THOUSANDS of dollars but I can't come up with any combination of codes that would make this correct.. from someone with experience, do you know about what this procedure should be reimbursing? I just want to make sure I am maximizing reimbursement but also only billing correctly. Thanks again!
 
Cassandra Stone said:
Thanks for your input Megan! So does your office just bill G0452 and accept the $20 as payment in full for this service? Our physician wants to be paid not so much for the collection but for reviewing the results/using it to determine which medications to prescribe. This will be where his time is spent in regards to this procedure. Another problem I have is medical supply reps that go in and tell the Dr. he will be reimbursed THOUSANDS of dollars but I can't come up with any combination of codes that would make this correct.. from someone with experience, do you know about what this procedure should be reimbursing? I just want to make sure I am maximizing reimbursement but also only billing correctly. Thanks again!
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Sooo I did a little investigating in our clinic, since I was aware that our physicians had started doing this awhile back, but I had never really been involved in it, and I found out that they didn't use the service for too long; from what I was just told, they didn't find that it was all that helpful. For the short period that we were using the DNA testing, we did not bill anything beyond office visits. The lab had staff here on site to collect samples, and the samples were sent to their lab elsewhere for processing. So no billable charges for us with any of that. I'd never heard of the G0452, but just did a quick search of it, and it looks like that code is intended for the pathologist that processes the samples and creates the report. We don't have any pathologists on staff, only the neurologists that were simply ordering the test, so that's not something we could have billed either. Not sure what your situation is as far as that goes. Honestly, if your providers are also only ordering the test, and reviewing the report that the pathologist at the lab created, I'd be hard-pressed to say they can charge anything extra. If reviewing the reports is taking up an extreme amount of extra time, I would recommend either time-based coding for the patients next follow-up visit, with proper documentation of course, or the non face-to-face codes mentioned above, with the expectation that not all payers will pay them.

Sorry I couldn't help more! :)
 
Hi Megan, I just got off the phone with another rep and he stated the reason the dr's office can bill for the path/lab codes is because they have a lab to lab agreement (which states the Dr. bills for the labs services and then the Dr. pays the labs?) I have never heard of this before, does anyone have any experience with this? It doesn't sound right to me.
 
Billing for purchased lab tests are not billable in every state, aka pass-through billing. In addition, a physician can not bill for purchased lab to any governmental payer, Medicare, Medicaid, Tri-Care, etc. or United Healthcare, regardless if the state allows it. It is important to check if your other payers would allow this as many of the state BCBS plans are also no longer paying for pass-through billing.

The review of the test results are considered to be part of the medical decision making key component and not separately billable.

The following is an excerpt from the November Federal Register:
We will monitor the utilization of this service and collect data on billing patterns to
ensure that G0452 is only being used when interpretation and report by a physician is medically necessary and is not duplicative of laboratory reporting paid under the CLFS.​

Be careful with the information provided by reps. We need to remember that they are sales people and unfortunately some are not totally truthful in order to make the sale.
 
Genesight

Hello. I am a new family practice coder and our office has started collecting swabs for genesight testing. These are generally collected while the patient is here for an E/M visit, but occasionally come back for a nurse visit because they wanted to think about it first. Can we bill 99211 for this or possibly 99000 or 99001? Or is this a non-billable service since we send it out to be resulted? Any suggestions? There are several different opinions in our office and we are looking to see what is the best practice for this.
 
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