Wiki New Drug Codes for 2016

[elenafrankie]

How is everyone handling the new codes?
We do a five panel so we have replaced the G0434 with G0477, but my question is, how do we bill for the independent test that used to have a Gcode? for ex.alcohol (G6040), salicylate (G6038) acetaminophen (G6039)
Would we use the G0480-G0483 dependent on the number of tests performed? and only bill one unit?

 

[CodingKing]

We have a few other threads on this. In summary The drug specific G codes have been deleted. replacement codes G0477-G0483 are the only codes that should be used with Medicare.

You can pick a maximum one of the 3 Presumptive codes (each code is a max 1 unit)

G0477
G0478
G0479

You can pick a maximum one of the 4 Definitive codes. (each code is a max 1 unit)

G0480
G0481
G0482
G0483

G0480-G0483 is based on the number of classes in CPT manual. You cant count metabolites separately from the drug class anymore.

 

[KMCFADYEN]

There is only one problem.
Medicare had an allowed reimbursement amount of $14.86 which was 75% of the allowed for G0434 but now shows reimbursement at zero.
our clearing house never loaded the new codes so all of our claims with a drug screen have rejected and when we brought it to their attention, the allowed amount went missing.
Anyone have any insight on this?

 

[CodingKing]

There is only one problem.
Medicare had an allowed reimbursement amount of $14.86 which was 75% of the allowed for G0434 but now shows reimbursement at zero.
our clearing house never loaded the new codes so all of our claims with a drug screen have rejected and when we brought it to their attention, the allowed amount went missing.
Anyone have any insight on this?

My only guess is the allowed amount was removed as an alert not to use the code. I don't know why they don't just add an end date of 12/31/15 for the G0434. If these are 2016 claims you shouldn't be using deleted codes. Your office should work with the clearinghouse to add the new 2016 codes. You may have to drop to paper. Even if they didn't kick back at the clearinghouse they would have gone through to Medicare and denied