Wiki Toxicology Lab Confirmation Question

[robertjsenese]

80353 Cocaine: Benzoylecgonine
80356 Heroin metabolite: 6-MAM
80357 Ketamine and norketamine: Ketamine, Norketamine
80358 Methadone: Methadone, EDDP
80359 Methylenedioxyamphetamines: MDA, MDEA, MDMA

That is a list of a few of the drugs being tested by the confirmation lab
OUT OF NETWORK pricing.

I have two questions:
1) should I be using 3 units for 80359, and 2 units for 80358,
or is it okay to just bill one unit for 3 drugs/ 1 unit for 2 drugs?
In other words, should I price 80359 at $150 for 1 unit, or 80359 $50 with 3 units.

2.) Should I be using just 304.90 and V71.09,
OR should I be using an ICD which crosswalks with each code,
304.90, 304.00, 304.40, V71.09

Thank you so much!

 

[niecey50]

Robert,

All of these codes mentioned below are 1 unit prefaced. I tired, it just doesnt work that way anymore unlike the Gcodes.

I suggest using the crosswalk for each code if the patient presents with those issues. The payors won't pay for a code that has an LCD but not used.

Hope that helps

Connie

 

[robertjsenese]

Thank you so much, niecey38. That helps a lot!

Also, the lab is performing the testing and billing,
and there is an ordering medical director for the test.

Therefore, should I, lets say, for BCBS,
be billing on an institutional claim, or a professional claim,
as an out of network lab?

And Neurotin (gabapentin) is a frequently abused drug by people in recovery,
they often steal a roommates medication, or take large amounts of the medication to experience a high.

80355 Gabapentin, non-blood, does not crosswalk with a substance abuse ICD code, since it is used for primarily for epilepsy and nerve damage. should I just use 304.90, although it doesn't crosswalk? or should I use
V72.60 Laboratory examination, unspecified, which does.


Thanks!