Wiki urine drug screen question

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metzger130

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We are going to be billing for urine drug screens. We will be using the 80,000 series or G codes as insurance requires. My question is how to bill a certain section of our toxicology report. There is a heading of "Synth Opiates" and under it is Buprenorphine, EDDP, Fentanyl, Methadone,, Oxycodone, Propoxyphene, Tapentadol, Tramadol. Will I bill each of these with separate cpt/hcpcs codes or is there 1 code that includes all these?

Thank you,
Rob
 
metzger130 said:
We are going to be billing for urine drug screens. We will be using the 80,000 series or G codes as insurance requires. My question is how to bill a certain section of our toxicology report. There is a heading of "Synth Opiates" and under it is Buprenorphine, EDDP, Fentanyl, Methadone,, Oxycodone, Propoxyphene, Tapentadol, Tramadol. Will I bill each of these with separate cpt/hcpcs codes or is there 1 code that includes all these?

Thank you,
Rob
Click to expand...

Using the 803xx series of codes, you will have a distinct code for most of the ones you mentioned. (EDDP is included with Methadone, so there won't be one for that). Using G codes, Methadone/EDDP has a code of G6053, all the others would be coded with a G6056. Be aware that the MUE for G6056 is 4, so all may not get paid. Also be aware that the G codes currently in use by Medicare will be expiring at the end of 2015. There is a new coding scheme involving tiered codes for 2016. Medicare has the details posted in the Laboratory section of the CMS website.
 
I'm extremely excited about the 2016 codes. Still wont stop unnecessary testing but at least cut down on overpayment due to inappropriate testing. Yes there are many labs out there that every quantitative test under the sun, even on negative results from qualitative.
 
I saw the new code for the drug screens and am not a fan of it at all. Our lab does drug screens not only for doctor offices but also for treatment centers. The treatment centers like to check for many things, as they should since they are a treatment center and want to make sure these people stay clean, and looking at how much they want to pay next year compared to now is a HUGE decline.
 
metzger130 said:
I saw the new code for the drug screens and am not a fan of it at all. Our lab does drug screens not only for doctor offices but also for treatment centers. The treatment centers like to check for many things, as they should since they are a treatment center and want to make sure these people stay clean, and looking at how much they want to pay next year compared to now is a HUGE decline.
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It cant be a big blow. How many drugs of abuse are the patients testing positive for on a qualitative screening? I'm just trying to understand how you all are getting to billing $1,000-$2,000 screenings.

Maybe I'm just misunderstanding bills such as the following codes billed every 3 days on a single patient:

80346
80323
80321
80345
80349
80351
80361
80365
80348
80354
80358
80362
80371
80360
80353
80370
80368
80357
83992
80376
82570
83986
81003
84311
 
I am not liking the new format. It looks like the reimbursement of waived cups will be cut in half (which would be about 50% margin on the pure cost of the cup and dip stick) and CMS' recommendation for the fee schedule for table top high complexity analyzers would be over 30% lower, and this is after dropping the reimbursement by 80% after killing the per panel model. This would effectively kill presumptive testing in the substance abuse field. If my math is correct a CLIA and COLA certified high complexity lab employing a single medical technologist would have to run well over 1000 samples per month just to break even. (A responsible 70 bed facility will only run about 800)

As for definitive testing, maybe my math is off, but the max reimbursement for 35 or more classes seems ridiculously low and averages to something like $4.75 per drug class. The reagents cost more than that.

Maybe my math is wrong and please correct me if it is, but these recommendations from the October meeting scare the crap out of me.
 
I agree that it looks very low. I am looking at the final determination and it is not saying whether or not the urinalysis is included in the code or we can bill that separately?
Also, if I understand correctly no matter how many benzo's they check for or opiates or skeletal muscle relaxants, you can only count it as 1 drug class. so if they check for 1 benzo you say count that as 1, if they check for 13 benzo's you still can only count that as 1. Is this correct? Just like there are many drugs that fall under G6058 currently. So no matter how many of those you check for you can only count as 1 in your counting of the number of drug classes?
 
metzger130 said:
I agree that it looks very low. I am looking at the final determination and it is not saying whether or not the urinalysis is included in the code or we can bill that separately?
Also, if I understand correctly no matter how many benzo's they check for or opiates or skeletal muscle relaxants, you can only count it as 1 drug class. so if they check for 1 benzo you say count that as 1, if they check for 13 benzo's you still can only count that as 1. Is this correct? Just like there are many drugs that fall under G6058 currently. So no matter how many of those you check for you can only count as 1 in your counting of the number of drug classes?
Click to expand...

Can you please give me an update about the changes? I am new doing billing for a lab company and the HCPCS book is the wrong printed version.

Thanks

Isvel
 
Medicare is going to a single code for drug screen testing instead of the G codes they set up last year.

For definitive testing
G0480 1-7 drug classes
G0481 8-14 drug classes
G0482 15-21 drug classes
G0483 22 or more drug classes

I would recommend going to CMS's website and printing out the 2016 clinical Laboratory fee schedule final determination as it has a breakdown on what is considered a drug class.


AMANDACARLA said:
Can you please give me an update about the changes? I am new doing billing for a lab company and the HCPCS book is the wrong printed version.

Thanks

Isvel
Click to expand...
 
metzger130 said:
Medicare is going to a single code for drug screen testing instead of the G codes they set up last year.

For definitive testing
G0480 1-7 drug classes
G0481 8-14 drug classes
G0482 15-21 drug classes
G0483 22 or more drug classes

I would recommend going to CMS's website and printing out the 2016 clinical Laboratory fee schedule final determination as it has a breakdown on what is considered a drug class.
Click to expand...

To add the drug classes match the CPT book so drug class assignment is not changing

Also

For Presumptive (qualitative)
G0477 - Optical only
G0478 - Instrument assisted optical
G0479 - Instrument only

Per the 2016 clinical Laboratory fee schedule final determination you can only bill one of these 3 presumptive per patient encounter (this does not mean split claims into 2 days). This includes sample validation (the tests you run to make sure its a good enough sample for accurate testing)
 
Another question, beside the two codes (for quantitative and qualitative tests):

Should I still code 81003 and 82542? What about Specimen validity codes 82570, 84311, 83986?

Thank you :)
 
For Medicare and any payers that adopt the new HCPCS "G" codes, specimen validity testing is not separately billable. The code descriptors for all the new codes specifically include specimen validation testing when performed.

In addition, Medicare added verbiage in the 2015 NCCI manual: " Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed. The Internet-only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 16 (Laboratory Services), Section 10 (Background) indicates that a laboratory test is a covered benefit only if the test result is utilized for management of the beneficiary’s specific medical problem. Testing to confirm that a urine specimen is unadulterated is an internal control process that is not separately reportable."

So no billing of 81003, 82570, 84311, 83986 for specimen validity testing. The 82542 CPT code was revised for 2016 and would not be reported for drug testing - Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

For Medicare and any payer that adopts the new HCPCS "G" codes, the maximum will be 2 codes - 1 for the presumptive testing and 1 for the definitive testing.
 
I'm in Missouri and Medicaid will not accept the new G codes. They told us to bill 82542 up to 99 units. If we bill it this way they will pay an additional $200.00 per patient. I feel very uncomfortable billing this. Please advise.
 
83789 cpt 2016

our billing company bills out 83789, 82492,82542 and these are not on the Michigan Medicaid fee schedule. Is there a replacement code? How does someone determine what other code to use. We are getting denials as non covered on these codes mostly. Please advise
 
JackieZS said:
our billing company bills out 83789, 82492,82542 and these are not on the Michigan Medicaid fee schedule. Is there a replacement code? How does someone determine what other code to use. We are getting denials as non covered on these codes mostly. Please advise
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82492 termed as a code 1/1/16
83789 & 82542 had a description change eff 1/1/16 its not for drug analyses anymore.

Are you asking what to bill for drug screens? If so and they are denying they want G0477 - G0483 as some medicaid agencies did adopt CMS rules.

Have you contacted medicaid? Medicaid is administered at the state level and all states treat these things differently.

I looked and the CPT codes you asked about are not listed on the MI Medicaid lab fee schedule for June

http://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_42542_42543_42546_42551-150939--,00.html

Their page says: Any questions should be directed to Provider Inquiry, phone toll-free 800-292-2550 or email at providersupport@michigan.gov.
 
Last edited:
vijayarani9369@gmail.com said:
Hi,

Can anyone pls clarify what code should be used instead of G0483, as client states that they cannot justify this G-code for billing for the services done.

Thank you
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For definitive testing, G0480 - G0483. There is always a possibility of limited payers not following CMS and allowing 80320-80377 series but few and far between.
 
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