Wiki New Drug Testing Codes 2015

Create Wiki
D

dwaldman

True Blue
Messages
1,638
Location
Overland Park, KS
Best answers
0
http://www.ama-assn.org/ama/pub/phy...ur-practice/coding-billing-insurance/cpt.page


801XXX1 Drug screen, any number of drug classes from Drug Class List A; any number of non- TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service

801XX2A Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service 

801XX4A Drug screen, presumptive, single drug class from Drug Class List
B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure 

801XXX6 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC)(eg, acid, neutral, alkaloid plate), per date of service 

801XXX7 not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure 

Drug Class A

Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants

Drug Class B

Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified
 
Im confused I work for a pain management dr. and we do the Preliminary screening in the office and its for multiple panel we test for Narcotics we are CLIA waived. Once we the preliminary the urines are then sent to the outside lab for the final. We are curently using G0434, G0431 and 80104. Will these codes be changing in 2015?
 
Yes, it appears the AMA are rolling out some new codes but are not finalized yet. And it is unclear if Medicare will switch over to these codes or stay with the G0434 or G0431 codes.

Their below new code would replace 80104 and would be for a drug test kit/cup for Drug Class List A, which they indicate which codes fall under this selection.

801XXX1 Drug screen, any number of drug classes from Drug Class List A; any number of non- TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service

They have an additional code that appears to replace 80101 as seen below which involves drugs from Drug Class List A

801XX2A Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service

Then they have a code for testing done for drugs listed in Drug Class List B

801XX4A Drug screen, presumptive, single drug class from Drug Class List
B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure 

Below is their break out of Drug Class A & B

Drug Class A

Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants

Drug Class B

Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified
 
Presumptive Drug Class Procedures

80300 Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service

80301 Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service

80302 Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure80303 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (eg, acid, neutral, alkaloid plate), per date of service

80304 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure

Drug Class A

Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants

Drug Class B

Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified

Definitive Drug Class Procedures

80320 Alcohols
80321 Alcohol biomarkers; 1 or 2
80322 Alcohol biomarkers; 3 or more
80323 Alkaloids, not otherwise specified
80324 Amphetamines; 1 or 2
80325 Amphetamines; 3 or 4
80326 Amphetamines; 5 or more
80327 Anabolic steroids; 1 or 2
80328 Anabolic steroids; 3 or more
80329 Analgesics, non-opioid; 1 or 2
80330 Analgesics, non-opioid; 3-5
80331 Analgesics, non-opioid; 6 or more 1 or 2
80332 Antidepressants, serotonergic class;1 or 2
80333 Antidepressants, serotonergic class; 3-5
80334 Antidepressants, serotonergic class; 6 or more
80335 Antidepressants, tricyclic and other cyclicals; 1 or 2
80336 Antidepressants, tricyclic and other cyclicals; 3-5
80337 Antidepressants, tricyclic and other cyclicals; 6 or more
80338 Antidepressants, not otherwise specified
80339 Antiepileptics, not otherwise specified; 1-3
80340 Antiepileptics, not otherwise specified; 4-6
80341 Antiepileptics, not otherwise specified; 7 or more
80342 Antipsychotics, not otherwise specified; 1-3
80343 Antipsychotics, not otherwise specified; 4-6
80344 Antipsychotics, not otherwise specified; 7 or more
80345 Barbiturates
80346 Benzodiazepines; 1-12
80347 Benzodiazepines; 13 or more
80348 Buprenorphine
80349 Cannabinoids, natural
80350 Cannabinoids, synthetic; 1-3
80351 Cannabinoids, synthetic; 4-6
80352 Cannabinoids, synthetic; 7 or more
80353 Cocaine
80354 Fentanyl
80355 Gabapentin, non-blood
80356 Heroin metabolite
80357 Ketamine and norketamine
80358 Methadone
80359 Methylenedioxyamphetamines (MDA, MDEA, MDMA)
80360 Methylphenidate
80361 Opiates, 1 or more
80362 Opioids and opiate analogs; 1 or 2
80363 Opioids and Opiate analogs; 3 or 4
80364 Opioids and Opiate analogs; 5 or more
80365 Oxycodone
80366 Pregabalin
80367 Propoxyphene
80368 Sedative hypnotics (non-benzodiazepines)
80369 Skeletal muscle relaxants; 1 or 2
80370 Skeletal muscle relaxants; 3 or more
80371 Stimulants, synthetic
80372 Tapentadol
80373 Tramadol
80374 Stereoisomer (enantiomer) analysis, single drug class
80375 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3
80376 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 4-6
80377 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 7 or more
 
G6030 Amitriptyline Assay of amitriptyline
G6031 Benzodiazepines Assay of benzodiazepines
G6032 Desipramine Assay of desipramine
G6034 Doxepin Assay of doxepin
G6035 Gold Assay of gold
G6036Assay of imipramine Assay of imipramine
G6037 Nortriptyline Assay of nortiptyline
G6038 Salicylate Assay of salicylate
G6039 Acetaminophen Assay of acetaminophen
G6040 Alcohol (ethanol); any specimen except breath Assay of ethanol
G6041 Alkaloids, urine, quantitative Assay of urine alkaloids
G6042 Amphetamine or methamphetamine Assay of amphetamines
G6043Barbiturates, not elsewhere specified Assay of barbiturates
G6044 Cocaine or metabolite Assay of cocaine


G6045

Dihydrocodeinone

Assay of dihydrocodeinone


G6046

Dihydromorphinone

Assay of dihydromorphinone


G6047

Dihydrotestosterone

Assay of dihydrotestosterone


G6048

Dimethadione

Assay of dimethadione


G6049

Epiandrosterone

Asssay of epiandrosterone


G6050

Ethchlorvynol

Assay of ethchlorvynol


G6051

Flurazepam

Assay of flurazepam


G6052

Meprobamate

Assay of meprobamate


G6053

Methadone

Assay of methadone


G6054

Methsuximide

Assay of methsuximide


G6055

Nicotine

Assay of nicotine


G6056

Opiate(s), drug and metabolites, each procedure

Assay of opiates


G6057

Phenothiazine

Assay of phenothiazine


G6058

Drug confirmation, each procedure

Drug confirmation





G0431

Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
 
Below link has some new HCPCS codes for 2015 and it appears they will retain G0431 and G0434 for 2015 because one of the files in the link states "No Change."

http://www.cms.gov/Medicare/Coding/...CS-Items/2015-Alpha-Numeric-HCPCS-File- .html

G0434 Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter

G0431 Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
 
80375, 80376,80377

Does anyone have any insight if 80375, 80376,80377 will replace or be in addition to 82541, 82542, 82491, 82492?
 
Below is from AMA CPT Changes 2015

"Code 82541 (parent code to codes 85242-85244) has been revised to specify "non drug" analyte in the descriptor. A parenthetical note has been added to direct users to new codes in the drug assay subsection to report column chromatography/mass spectrometry of drugs"

The other codes you mention CPT 82491/82492 would not be separately reported with the new definitive drug testing codes. The clinical example describe these methods being used under the definitive drug testing codes and will not require supplemental codes (82541-82544; 82491-82492) in 2015.
 
The below had not been included in this thread. CMS describes delay in pricing for CPT 80300-80377. And the G0431/G0434 on future fee schedule in 2015.


Codes 80300 through 80377 (63 codes)
Industry Recommendation: Various, from crosswalking to specific existing codes (e.g., G0434, G0431, etc.), to gap filling.

CMS Recommendation: Delay in pricing.

Rationale: These codes represent various drug screening codes, many of which are specific to individual drug testing. While we appreciate the recommendations for these tests, we are concerned about the potential for overpayment when billing for each individual drug test rather than a single code that pays the same regardless of the number of drugs that are being tested for. Therefore, it is our recommendation to delay pricing for these codes at this time, until further information and education is obtained.
 
Thanks for the link to the HCPCS coding. I also see in the table all the new G-codes have this value in the BETOS field:

T1H = Lab tests - other (non-Medicare fee schedule) as opposed to:

T1G = Lab tests - other (Medicare fee schedule)

This further confirms these new codes will not be payable by Medicare and we should continue to bill with G0434 and G0431.
 
For our laboratory, the insurance companies have been denying payment of the new drug codes. I am having an issue with 80323 Alkaloids, not otherwise specified- its being denied for reason"the unlisted code is disallowed because a description of the service is required but was not received. But if you call the insurance company they will resubmit the code for reprocessing.
 
Can someone tell me if they are billing multiple units of the gcodes to Medicare other than G6056 that states each procedure?

Thanks
 
You must log in or register to reply here.
Top