Wiki G0431 and G0434

[natashabarnes]

I work for an independent laboratory and we are billing G0431 for the drug screen but the doctors office that sends us the sample is billing the G0434 does anyone know the guidelines in this situation. Are we not suppose to bill the G0431 or is the doctor's office not suppose to bill the G0434? The problem is that Medicare is saying that they will only pay for one per day regardless of who bills so the doctor's office claims are getting denied and ours are getting paid? Thoughts...

 

[Walker22]

There seems to be a disconnect between you and your clinic. If the clinic is using POC cups to do the presumptive testing, then they would bill G0434. There should be no reason for your lab to also run a presumptive test on the same sample. Medicare is right, only once per day is all that is medically necessary. If the clinic is not using the POC cup and relying on your lab to do the presumptive testing, then you should be billing G0431 and they should not be billing anything.

 

[combilling]

Lab coding please help!

Hi I was wondering if any coders out there can please please help me?? I have a lot of billing experience but new to lab billing and coding. I am so confused and if anyone could help me that would be great!!

Does anyone know if you bill G0431 are you allowed to bill for any other 8 codes. I know G0431 includes some codes but cant find which ones? Currently we are billing G0431,84311,82570. Do you bill 8 codes individually to commercial insurance and just use G codes when billing Medicare?

Our lab does qualitative drug screenings. Here is a list of test we do.

Amphetamines
Barbiturates
Benzodiazepines
Buprenorphine
Cannabinoids
Cocaine Metabolites
Fentanyl
Methadone
Opiates
Oxycodone
PCP
Specific gravity
Tramadol

 

[JohnBox]

I am in the same boat too. I am trying to find out on the G0431. I need to know if what combilling is asking it this can be done with the G0431 or can this only be done with the commercial carriers. Need help on this issue.

 

[Walker22]

Combilling and JohnBox, I am unsure what is being asked here. Private message me with your specific questions and I will try to help you find the answer.