Wiki Urinary Drug Testing Inconsistencies Coding

[charleahayes]

Does inconsistent lab results warrant an upcoding in the definitive CPT code? Ex: if we tested 7 drug classes (G0480) and the patient tested positive on 5 of those classes in which we performed additional testing to test the quantity, does that warrant a G0481 due to the additional testing?

 

[CodingKing]

No. the test on the 7 classes was a different kind of test than what is reported under the G0480-G0483 range. G0480 is for the 5 quantitative.

 

[karamac]

Does inconsistent lab results warrant an upcoding in the definitive CPT code? Ex: if we tested 7 drug classes (G0480) and the patient tested positive on 5 of those classes in which we performed additional testing to test the quantity, does that warrant a G0481 due to the additional testing?

G0480 is for definitive testing of 1-7 drug classes as identified by the AMA. To clarify, are you saying the provider ordered an additional 5 drug classes on the same specimen based on the results of the first run of testing performed billed as G0480? A laboratory cannot not automatically interpret or reflex based on what they consider inconsistent. The term inconsistent is being phased out by most clinical laboratories in the drugs of abuse arena because clinical laboratory can't tell a provider if a patient is inconsistent or consistent due to how an individual metabolizes medications. I think you may be confusing your initial presumptive screen with definitive testing as CodeKing suggests. The billing of the G-code is for the performance of the work, and is not ever based on the results. My guess is that you performed an presumptive screen on 7 drugs classes (80305-80307) depending on your method, and the provider then wanted to definitively test the 5 positive results of that screen. How and which drug classes were sent to definitive screening will determine what code you will then bill. There is not a one to one relationship between presumptive drug classes, and AMA drug classes. This varies based on the presumptive devices you are using.

Quantitative or Quantitative results are not the determinant of the code that is billed, it is the methodology that is performed. In the setting of a clinical laboratory, if a provider requested additional drug classes, that were medically necessary for the treatment of the patient, on the same specimen, technically, the laboratory could bill for that work. However, G-Codes make this difficult, and it requires the laboratory if the claim has already been submitted, to then cancel that claim, and re-submit with the new code. A Physician who has definitive technology in place can also do this as well. The key is communication with the payer as you would NOT bill both codes, it is one or the other. Additionally, you would need a documented test order for those additional drug classes.