Wiki Urine drug screen in physician office

[bfontes]

I work in a pain management office and we recently started doing UDS in office. My understanding is that the two codes I am to use are G0431 and 80101. The reimbursement on the G0431 is not what my administrator (who is not a coder) had expected. When doing his research for setting up the lab, he met with several people and was told by one that we could bill each drug we are testing for individually. I would appreciate any input from anyone with experience has to offer.

 

[ediepierre]

Hi there. I work with a Pain Management office as well so I understand your pain What I have found is that Medicare along with Cigna and Blue Cross and Blueshield require G0434 without any modifier if it is high CLIA or G0434 with the QW modifier if it is CLIA waived (just be sure to include the CLIA number when you send the claim in for CLIA waived). Some commercial insurances require you to use 80104 (same as the other, QW modifier if CLIA waived and no modifier if high CLIA). I was getting many rejections until I found this information and now they are paying with no problems. I hope this helps. The website that gave me this information was www.alfascientific.com under Frequently Asked Questions. I just wish someone could help me with the injections

 

[capricew]

I work in a pain management office and we recently started doing UDS in office. My understanding is that the two codes I am to use are G0431 and 80101. The reimbursement on the G0431 is not what my administrator (who is not a coder) had expected. When doing his research for setting up the lab, he met with several people and was told by one that we could bill each drug we are testing for individually. I would appreciate any input from anyone with experience has to offer.

I have anwers for this but the question I ask you is- are you doing High complexity lab testing using an individual assay for each drug class with high complexity lab equipment or are you simply doing a dipstick test using a multi-test urine cup? The difference is huge and you need to be sure you are coding for the right test.

G0431 is the code to report to Medicare for High Complexity testing with high complexity lab equipment. (You must have a high complexity certificate to bill this) This code can only be billed at one unit.
80101 is the commercial carriers equivalent code for G0431 although many carriers now require you report the same code as Medicare. You will have to check each payers policy to know which code to bill. This code can be billed up to 10 units.

G0434 is the code you bill to Medicare if you are doing a simple rapid urine cup or dipstick test that tests multiple drug tests at the same time and it can only be reported once.
80104 is the commercial carriers equivalent code to G0434 and can only be reported once. Again, many carriers now require providers only report the Medicare code G0434 so check each commmercial carriers policy on this.


So it really depends on which test you are performing...

Hope this helps

Caprice Walder, CPC

 

[bearybubba2008]

Qualitative and Quantitative

So if I'm reading this correctly, these are qualitative tests, correct? What do you do for quantitative? Would you use the 80299 and also use a -59 modifier?

Thank you!

 

[capricew]

So if I'm reading this correctly, these are qualitative tests, correct? What do you do for quantitative? Would you use the 80299 and also use a -59 modifier?

Thank you!

the qualitative tests are reported with the 80104/G0434
and the quantitative are reported with the 80101/G0431

sorry i did not use that terminology previously...

 

[ADD1919]

Hoping this is on the same question... one of my Pain Management offices was billing 80101 in 2012 but just got audited and had a takeback done by UHC for all of those exams stating the codes 80101 and 80104 are not on the CLIA waived list and that the Dr's CLIA number does not approve of him doing those procedures in the office. I suppose you would need to make sure the Dr has a valid CLIA number for the tests being performed in the office?