Wiki Procedure Code 80307

[Mgingras]

Hi All!

I work for an auditing company that reviews/audits claims for multiple different insurance companies. I have come across the following scenario now twice and was hoping for some guidance/clarification. Can/should CPT code 80307 (presumptive drug class screening) be billed on both a professional and facility claim for the same DOS? If not, which one would be the most correct one? Any feedback would be greatly appreciated, thanks!

Maria Gingras RN

 

[CodingKing]

PC/TC concept doesn't apply to the drug screen codes. I'd say the Facility claim is the correct once. Its not a CLIA waived test so should only be performed by the laboratory with the advanced equipment and CLIA certificate.

 

[tjbd57]

80307

Cpt code 80307 should only be billed one time per DOS. The location/facility that performs the actual testing should be the one to bill for the service. If performed in the office setting and CLIA certified, the provider should bill for 80307. Validation of the specimen is included in the code description and cannot be separately billed.

 

[karamac]

Agree with the other responses-- I would think that this is most likely a scenario where they were pass-thru-billing the specimen and the ordering provider was billing his interpretation of the results (mistakenly) as the professional component- this is what I have seen occur previously after the payer denied the intial claims because the payer did not allow pass thru billing.

That should be a fun one!