Wiki Please help with drug screen codes!

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genawaller

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I am in need of advice when coding Drug screens. Are you billing 80101 or 80104 for multiple drugs screened? We are having some confusion in our office. We currently bill 80101 X the amount of drugs screened for. Also, I spoke with Cigna today over a denied claim for 80101, they told me I have to code the G code instead. PLEASE HELP!
 
genawaller said:
I am in need of advice when coding Drug screens. Are you billing 80101 or 80104 for multiple drugs screened? We are having some confusion in our office. We currently bill 80101 X the amount of drugs screened for. Also, I spoke with Cigna today over a denied claim for 80101, they told me I have to code the G code instead. PLEASE HELP!
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I have anwers for this but the question I ask you is- are you doing High complexity lab testing using an individual assay for each drug class with high complexity lab equipment or are you simply doing a dipstick test using a multi-test urine cup? The difference is huge and you need to be sure you are coding for the right test.

G0431 is the code to report to Medicare for High Complexity testing (aka quantitative testing which shows the actual amount of the drug in the patient's system) with high complexity lab equipment. (You must have a high complexity certificate to bill this) This code can only be billed at one unit.
80101 is the commercial carriers equivalent code for G0431 although many carriers now require you report the same code as Medicare. You will have to check each payers policy to know which code to bill. This code can be billed up to 10 units.

G0434 is the code you bill to Medicare if you are doing a simple rapid urine cup or dipstick test (aka qualitative testing which tells you a yes or no result that a substance is present) that tests multiple drug tests at the same time and it can only be reported once.
80104 is the commercial carriers equivalent code to G0434 and can only be reported once. Again, many carriers now require providers only report the Medicare code G0434 so check each commmercial carriers policy on this.


So it really depends on which test you are performing...

Hope this helps
Caprice Walder, CPC
 
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