Wiki Lab Denials for Drug screening

[snwhite0730]

Hello Coders!

I am hoping someone can assist me. I work the lab denials for a large providers office. They see patients for chronic pain medications and run UDS at each visit. I have been getting denials and I cannot figure out why, or how I should be coding these out for billing. I was using Z51.81 with Z79.891 but the senior coder in the office says this isn't correct and I should list the conditions the patients are receiving care for ie M54. 50 with Z79.891. I also checked the NCD/LCD from CMS which says:

Group 1​

(278 Codes)

Group 1 Paragraph
For monitoring of patient compliance in a drug treatment program, use diagnosis code Z03.89 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.
For the monitoring of patients on methadone maintenance and chronic pain patients with opioid dependence use diagnosis code Z79.891, suspected of abusing other illicit drugs, use diagnosis code Z79.899.
G0480, G0481, G0482, G0483, G0659, 80305, 80306, 80307.
Diagnosis codes must be coded to the highest level of specificity.
For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Most of our patients have a diagnosis of F11.90 Opiate use, not dependence and the NCD says opioid dependence. How does anyone out there bill out their UDS and get them covered for medicare patients? I am very confused since I was billing with just the Z codes (senior coder says this is not the correct way to code the visits) because the encounter is for medication management (Pain management) and the patients are only seen for refills. Any lab coders out there that can offer me some guidance? I appreciate any type of feed back I can get. Thank you!

 

[TThivierge]

Hi Snwhte
In order to get paid you need to bill with a definitive dx code NOT a Z code first according to patient s problems. Only bill with some Z code which are first listed..check inside ICD10 manual. Insurance companies want a definitive dx reason FIRST why patient getting lab test . Is lab test for pain due to which illness or drug abuse? The provider or doc should give you a note or order for the reason. Use the proper dx code according to doc notations . If pt has opioid use (F11 block) or misusing aspirin look at dx F55 block) other psychotic drug habit go see list in dx section of F10-F19. G codes are usually used for Medicare patient. Understand use vs remission vs dependence too. Some dx codes are for children F90 And if the patent is pregnant and has sub abuse problem add F53 codes but add O99.34 to claim too. If applicable pay attention to 2 types of Z history codes personal or family related dx Z80- Z87. Use most Z codes last on claim not first...unless first listed Z codes. Add Depression or other chronic conditions if applicable and dx R45 list of dx codes if warranted. Cannot bill bipolar and depression dx together. Pain codes are usually G89 block and F45 but why pain ?Pain with Cancer is dx G89.3 Pain with back pain can be chronic G89.29 & M54.5 Pain dx are blocks M79 or M25 linked with organ or illness. Is it depression F32 or F33 can be due to back pain M54, M47 or M49 ? You can find better Z codes related to meds use in back of ICD10 manual section Appendix A. than using Z79.899 all the time. Watch out for Excludes 1 and intergal coding rules too.

Have you used dx Z51.81 or Z76.0 or Z02.83 or Z13.39 from providers notes?

From instructions listed above have a definitive dx first, then Z code last...that is way most insurance like it if you want to get lab test paid. And if no dx given to you can always use Z01.89
,
I hope I have helped you...let me know
Lady T

 

[jkyles]

Hello Coders!

I am hoping someone can assist me. I work the lab denials for a large providers office. They see patients for chronic pain medications and run UDS at each visit. I have been getting denials and I cannot figure out why, or how I should be coding these out for billing. I was using Z51.81 with Z79.891 but the senior coder in the office says this isn't correct and I should list the conditions the patients are receiving care for ie M54. 50 with Z79.891. I also checked the NCD/LCD from CMS which says:

Group 1​

(278 Codes)

Group 1 Paragraph
For monitoring of patient compliance in a drug treatment program, use diagnosis code Z03.89 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.
For the monitoring of patients on methadone maintenance and chronic pain patients with opioid dependence use diagnosis code Z79.891, suspected of abusing other illicit drugs, use diagnosis code Z79.899.
G0480, G0481, G0482, G0483, G0659, 80305, 80306, 80307.
Diagnosis codes must be coded to the highest level of specificity.
For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Most of our patients have a diagnosis of F11.90 Opiate use, not dependence and the NCD says opioid dependence. How does anyone out there bill out their UDS and get them covered for medicare patients? I am very confused since I was billing with just the Z codes (senior coder says this is not the correct way to code the visits) because the encounter is for medication management (Pain management) and the patients are only seen for refills. Any lab coders out there that can offer me some guidance? I appreciate any type of feed back I can get. Thank you!

Hi there, you don't say what sort of denials you're getting and should also look at your MAC's LCD for drugs of abuse testing.

I see two major problems:

1. COT patients should never, ever, be billed with a drug use/dependence code unless the doctor documents that the patient has a problem that is caused by their use of the drug. F11 codes are "Opioid use disorders" codes and the correct descriptor is F11.90 Opioid use, unspecified, uncomplicated.

2. Medical necessity/frequency for UDS for COT patients is based on the individual patient's risk of abuse. I doubt every patient requires a drug screen at every visit so your MAC may be challenging that. There have been several fraud settlements recently that involved excessive billing of UDS so it is on everyone's radar.