I work for a lab that does urine drug screening. I am trying to determine whether we are billing G0434 and G0431 correctly.
First, I wanted to determine whether we should be billing for high complexity or moderate complexity. I found my way to the FDA site and plugged in the equipment we use and found that the model we use is categorized as moderate complexity, so I determined that we should be billing G0434.
However, we also have a GCMS and do "Sim Scans", which to my understanding is High complexity and would be billed under G0431.
First, does it appear that my research and determinations were accurate? No one wants to be audited but I also don't want to "underbill". As a result of my research we are billing way more G0434s which have a significantly lower reimbursement than G0431. I could really use some guidance, here from those of you who have been doing this longer (I've only been here a year).
Secondly. since both tests use different methodologies, is it possible to bill for both on the same day using modifier -59 or -XS?
Our clients can order them both at the same time - a 6 Panel and a "Sim Scan" - would they both roll up under G0431 despite the fact that they are being run on two different pieces of equipment?
Thank you in advance for any assistance you can provide.
First, I wanted to determine whether we should be billing for high complexity or moderate complexity. I found my way to the FDA site and plugged in the equipment we use and found that the model we use is categorized as moderate complexity, so I determined that we should be billing G0434.
However, we also have a GCMS and do "Sim Scans", which to my understanding is High complexity and would be billed under G0431.
First, does it appear that my research and determinations were accurate? No one wants to be audited but I also don't want to "underbill". As a result of my research we are billing way more G0434s which have a significantly lower reimbursement than G0431. I could really use some guidance, here from those of you who have been doing this longer (I've only been here a year).
Secondly. since both tests use different methodologies, is it possible to bill for both on the same day using modifier -59 or -XS?
Our clients can order them both at the same time - a 6 Panel and a "Sim Scan" - would they both roll up under G0431 despite the fact that they are being run on two different pieces of equipment?
Thank you in advance for any assistance you can provide.
