Drug screen coding - G0477 and 80300

smontague

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Anyone else having trouble with the new drug screen coding? We have been using G0477 and 80300 and having issues with almost all payers...just wondering if anyone else is having the same trouble?

We've tried both with and w/out the -QW modifier and we've tried both codes. We have a suboxone program and so we do urine drug testing in-house, but we can't seem to get any of them paid.

Any insight or advice would be appreciated!
 
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Here's what I've read about, not that it helps much. I'm not 100% sure if any of it is true or not.

Claims were denied originally at the beginning of the year, then held up until (supposedly) April. Once April hit and the door was supposed to open, some/most/a lot of payers, and some clearinghouses, had not yet programmed the code correctly into their systems, even with the QW mod. Some payers are struggling because they "misunderstood" that April was the implementation month, and instead thought that was the month they should begin implementation. :rolleyes:

Apparently some payers, not sure which ones, decided that you cannot bill G0477 + 80300 for the same DOS. You have to pick one or the other. :rolleyes:

There's also some issues with certain payers, not sure which ones, deciding not to cover the service for different locations of service. :rolleyes:

Most of what I've come across was dated early JULY.

Suggestion: If your facility/office/etc has a Provider Rep for such and such payer, it might help to give them a call. Not for this particular problem, but with similar situations, we've been successful in working out "deals" to make due until things get up and running. BCBS has been particularly helpful.

P.S. Good luck with United Healthcare :D
 
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