hsmith67
Guru
Suppose G0480 is the only code from G0480-G0483 approved for reimbursement/on the fee schedule for a payer that makes up a considerable part of your payer mix. Suppose the provider is going to prescribe opiates for chronic pain and manage this pain long term. Suppose a new patient comes in to get established and seeks long term pain management. The prescribing physician wants to perform a G0481, G0482, or G0483 to see what he/she is dealing with, but the payer only reimburses G0480. Alternatively, an established patient may seem to be veering off the path of compliance or cause suspicion and the prescribing physician wants to perform a G0481, G0482, or G0483 to investigate suspicions.
Is it acceptable to perform G0481-G0483 and bill G0480 to get paid for G0480 so the test is not a complete loss of revenue? Given that G0481-G0483 technically includes (and then some) what is covered in a G0480, is it still wrong to down code what was performed and bill G0480?
Opinions are fine, but if you have relevant articles to refer me to, Medicare guidelines that speak to this specifically, etc. that would be most helpful.
Hunter Smith, CPC
Is it acceptable to perform G0481-G0483 and bill G0480 to get paid for G0480 so the test is not a complete loss of revenue? Given that G0481-G0483 technically includes (and then some) what is covered in a G0480, is it still wrong to down code what was performed and bill G0480?
Opinions are fine, but if you have relevant articles to refer me to, Medicare guidelines that speak to this specifically, etc. that would be most helpful.
Hunter Smith, CPC