G0659???

erinal

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I work for a pain management clinic and we have our own in-house lab (non-reference laboratory). Prior to 2017 we were billing G0479 for the presumptive screening and G0480 for the definitive screening without issue. So for 2017 G0479 was deleted and 80307 was the replacement code. So now we have been billing 80307 for the presumptive screening and G0480 for the definitive. Now we are having issues.

So we spoke with someone who advised us that we SHOULD be using G0659 instead of G0480 for our definitive/confirmation testing since we are a non-reference lab. The description for this code totally confuses me. It almost sounds like G0659 should be used for both presumptive and definitive testing (at the end of the code description it says "qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes") ? And furthermore G0659 says that it is crosswalked to G0479 and 80307?

Can anyone give me a bit of guidance on this I am totally lost.

Thanks in advance!​
 

dwaldman

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"Create a new G code that would recognize those laboratories that are performing a less sophisticated version of these tests than is usually performed in drug testing laboratories"

https://www.cms.gov/Medicare/Medica...ds/CY2017-CLFS-Codes-Final-Determinations.pdf

Link states the above in referencing the conception of G0659

When comparing the code that you mention you bill prior to 2017 such as G0480 compared to the availability of G0659 as of now. I would talk to the manufacturer's representative of the instrument in your facility and discuss the differences in the descriptors as below: (it important to note you mentioned qualitative or quantitative in G0659 but that is also found in G0480. The fact it states any number classes is a way to condense it to one code for this test method. The crosswalk is for the pricing based on 80307 seemed to be accepted by industry stakeholders in the memo.

As statement above I would talk to the representative from the manufacturer regarding the following statement in G0659 and if this more accurately describe the technique and standards that are being provided versus what was only available with G0480 in 2016 for confirmation type testing. Stressing the parts that state without


From G0659
"performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes)"

From the 2017 CMS clinical laboratory fee schedule with estimated reimbursement based on national amounts

80307 $79.81
G0659 $79.81

G0480 $117.65
G0481 $160.99
G0482 $204.34
G0483 $253.87




G0480 (Drug test(s), definitive, utilizing (1) 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 (eg, alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed)

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G0659 (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), excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes)
 
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