Wiki Texas work comp high complexity screen

[jenelite]

I am not familiar with Texas Workers compensation fee schedule. I have done some research and found out that the mirror Trailblazer Medicare.
In Trailblazers bulletin it states.....


The following codes should not be reported for the initial screen/preliminary result when performed by EIA:

G0431 – Drug screen, qualitative; multiple drug classes by high complexity test method.

CPT “Chemistry” section, codes 82000–84999.

CPT “Drug Testing” section, codes 80100–80104.

CPT “Therapeutic Drug Assays” section, codes 80150–80299.

This is saying you can not bill using a high complexity machine. Does this guideline also carry over to workers comp?

 

[dwaldman]

Below is the full statement. They are describing moderate complexity testing should not be reported with the codes they list. I don't know if they have fee schedule you could review to determine if they recognize the G codes Medicare created or AMA codes.

Pain Management Billers:
If you are a point-of-care provider that bills services to monitor drugs of abuse and submits a quantitative code, you may be at risk for an overpayment request.

In order to effectively treat chronic pain, physicians rely on drug testing to monitor prescribed medications and drugs of abuse. Practices may purchase or lease enzyme immunoassay (EIA) devices to provide preliminary qualitative or semi-quantitative test results for monitoring purposes. EIA devices and the reagents used to perform in-office drug testing are FDA cleared only to obtain qualitative or semi-quantitative initial screen/preliminary results.

Since an immunoassay and an enzyme assay are by definition moderate complexity tests that produce qualitative and semi-quantitative results, they may not be reported with a quantitative code. Confirmation or quantification of the preliminary result is not usually produced in a point-of-care setting.

The initial drug screen/preliminary result should be reported with HCPCS code G0434, (Drug screen other than chromatographic; any number of drug classes), by CLIA waived test or moderate complexity test, per patient encounter.

The following codes should not be reported for the initial screen/preliminary result when performed by EIA:
•HCPCS code G0431 – Drug screen, qualitative; multiple drug classes by high complexity test method
•CPT Chemistry section, codes 82000-84999
•CPT Drug Testing section, codes 80100-80104
•CPT Therapeutic Drug Assays section, codes 80150-80299

Use of the above codes to report preliminary qualitative or semi-quantitative test results is considered systematic up-coding and may lead to criminal and civil penalties.