Wiki Drug Testing Coding

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KristinM522

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Hello All-

I am completely new to pain management, other than coding for epidural injections. We recently hired a Pain Management doctor and he started doing in office drug testing with "point of care" cups. I am not entirely sure how to bill them, the rep said we can bill medicare with code G0434 and other payers with 80300 and work comp with 80101 (which is no longer in the CPT book) can anyone help me out with how to really code the 3 different payers please?? I don't know the first place to start when looking, I've tried to just google it but the information isn't clear to me. Oh we are a CLIA waived testing facility is that makes any difference

Thanks in advance for any advice you can offer!
 
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Below is an example that for Aetna requiring the G code instead of the AMA code. I believe you will find other private payers require the G code also. I would review the Work comp fee schedule of the carrier you are going to bill to see at what year that fee schedule is at and if they potentially follow CMS fee schedule instead or at 80104 or update to date with 80300. Or still at a old fee schedule at 80101 which could result in an overpayment since this was recognized not for point of care testing through drug test kit and replaced with 80104 then 80300.
AETNA – Qualitative Drug Screens
Effective Date: June 1, 2012

Effective June 1, 2012, Aetna will require the use of either of the following codes and will reimburse for 1 unit, per patient encounter, of either code when qualitative testing methods are used.
•G0431– Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter, or
•G0434 Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

The above codes will replace the following codes. Any billing of the following CPT codes will be adjudicated according to this policy with appropriate mapping to one unit of G0431 or G0434 per patient encounter.
•80100– (Drug Screen, qualitative; multiple drug classes, chromatographic method, each procedure),
•80101– (Drug Screen, qualitative; single class method, each drug class), or
•80104 – (Single-drug test device other than chromatographic, multiple drug classes, per patient encounter),





Below are the new codes such as G0477 which would be point of care testing that would replace G0434
https://www.aapc.com/blog/32826-cms-...s-corrections/

G0477 l Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service

G0478 Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service

G0479 Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service

G0480 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed

G0481 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed

G0482 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed

G0483 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed
 
Thank you dwaldman for all of the information, I had no idea the codes were changing next year as well. I GREATLY appreciate your help!
 
One more question: My provider is saying we can bill work comp per panel, i.e. we can bill 1- 12 panel cup x12 units because he is testing for that many drugs.. That seems a little much to me, but does anyone else do it this way?
 
Controlled Substance Monitoring and Drugs of Abuse Coding and Billing Guidelines

DWALDMAN,
I am in the same position as KristinM522, new, but in my case I am doing the coding for the Lab company. Could you please help me to understand the 2016's rules of billing for Controlled Substances Drug testing? I received a report with a customized tests panel that include:
Amphetamine - 4 tests
Anti-convulsants - 2 tests
Barbituates - 5 test
Benzodiazepines -13 tests
Illicits - 9 tests
Opiods -7 tests
Synthetic Opiods -14 test
Antidepressants - 6 tests
Speciment Validity - 3 test
How do I code these test?
I would really appreciate your help.
Thanks
Isvel
 
There is no such thing a testing panel for drug toxicology. Its not medically necessary to do any quantitative testing of drug classes not testing positive on the qualitative test.

You pick one of the following G0477, G0478, G0479 for the Presumptive (qualitative) testing (includes the sample validation)

If any of the drug classes come up as positive on the Presumptive test, you can then run a more detailed quantitative exam

For Definitive (Quantitative) You pick one of the following codes based on the number of drug classes (Metabolites within that drug class are not counted separately)

G0480 1-7
G0481 8-14
G0482 15-21
G0482 22+

The drug classes per AMA Guidelined in the CPT book.

For example ion your sample you did 13 Benzodiazepines tests. That counts for 1 drug class not 13.
 
G0477,qw

I am having difficulty with getting the straight information on the new UDS codes. I work with a pain medicine group that uses Athena Health and find that the "QW" is not valid with the HCPCS code G0477. I looked for the code on CLIA waived listing and do not find it. Am I missing something, or are the Feds just slow to update?
 
AMANDACARLA said:
This means that I will only code 2 codes? G0479 and G0481

Is it the same rule with all commercial and Medicaid insurances too? Only 2 codes?

I really appreciate your time to answer me back.

Thanks

Isvel
isvel@commonwealthbilling.com
Click to expand...

Medicaid is a federal/state program that loves the HCPCS book over CPT book so likely to follow Medicare. Commercial it depends. Some follow Medicare and some don't. I had initially heard one can bill up to 3 presumptive but must have heard wrong based on the final rule. Maximum of 1 presumptive and 1 definitive G code per day. No cant divide up into 2 days as DOS is the specimen collection day, not when you get around to analyzing the sample.

Heres the link to the final rule:

https://www.cms.gov/Medicare/Medica...ds/CY2016-CLFS-Codes-Final-Determinations.pdf

Starts on page 1.
 
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Drug classes

We are trying to set up rules in our billing system for the new codes so we do not have to manually enter these.

How are others of you setting up your systems for the different classes?

I am especially interested when there is a presumptive test that has a positive. You bill a presumptive code and then it needs to be included in definitive class also.

Any suggestions on how others are doing this are greatly appreciated.
 
CodingKing said:
Medicaid is a federal/state program that loves the HCPCS book over CPT book so likely to follow Medicare. Commercial it depends. Some follow Medicare and some don't. I had initially heard one can bill up to 3 presumptive but must have heard wrong based on the final rule. Maximum of 1 presumptive and 1 definitive G code per day. No cant divide up into 2 days as DOS is the specimen collection day, not when you get around to analyzing the sample.

Heres the link to the final rule:

https://www.cms.gov/Medicare/Medica...ds/CY2016-CLFS-Codes-Final-Determinations.pdf

Starts on page 1.
Click to expand...

Thank you
 
KristinM522 said:
One more question: My provider is saying we can bill work comp per panel, i.e. we can bill 1- 12 panel cup x12 units because he is testing for that many drugs. That seems a little much to me, but does anyone else do it this way?
Click to expand...

Hi Kristin, I too am new to the maze of lab billing. However, regarding your workers comp issue I may be able to offer some help. Since workers comp rules are driven by state laws and regulations you would need check your local workers comp fee schedule or reimbursement rules. I am in NYS and while our workers comp fee schedule is stuck in the ancient year of 2012, the rule from that year still in effect is:

"When urine drug screening is performed in an office setting using a quick or rapid screening test method utilizing a stick/dip stick, cup or similar device, reimbursement shall be limited to one unit of 80101 for a single drug class OR 80104 for two or more drug classes regardless of the number of drug classes tested or reported per date."


Hope this helps,
 
Can we charge patients for code G0477

I work for a pain management doctor. We have had a difficult time getting code G0477 reimbursed by all of the insurance companies. I read somewhere that Medicare was not paying this code until 4/1/16. We have not received any reimbursement from Medicare or commercial insurance companies at all this year. My doctor would like to start charging the patients a fee of $15.00 - $20.00 per collection because we have to fill out the recs and we are not being reimbursed for our time. Is this legal?

Thank you,

DDenson
 
Shannon,

Both 80307 & code from the definitive code can be reported on the same date of service.

But you need to confirm that the confirmation testing does not fall under G0659 which could be for in office instrument that does not meet the standards of codes such as G0480-G0483

Additionally, Need to look at the Medicare LCD and other payer policies to see if they will only cover confirmation or definitive testing for positive result or unexpected negative result. If that is the case, the number of drugs that were actually positive and the provider needed confirmation would needed to take account.
 
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