Wiki Workers Comp Lab Billing

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tammyr

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Hi,
My name is Tammy and I am having an issue with the lab charges for Workers Comp. The doctor I handle his billing for is using the 80101 code then he sends the specimen to the lab so they can check the quantity of the drug used. But the lab is getting paid before us I have been on the phone countless hours trying to talk to adjustors and I am not getting anywhere. Can anybody please help me I am sure I am using the correct code but is there something else I need to be doing?


Thank you,
Tammy R. Dixon, CPC
 
Is the provider just taking the sample and then sending it out, or is he doing a POC testing then sending it out for further testing. There may be more documentation needed, such as the office lab results. If the provider is only taking a sample then there would be no
reimbursement for testing due since no in office testing was performed. If the provider did test for classes of drugs 80101 is the correct code but supporting documentation, as I mentioned above, such as what was tested, with results, would be needed. If the lab did all the work, and the provider no work, then the lab would be the one to get reimbursed. Hope this helps.
 
The doctor is taking the sample in the office and it is in a cup with a label on the side that tells the doctor the presence of drugs are in the system then he sends off to the lab for the quantity, he wants to make sure they are taking their medication correctly. He has been getting paid for years doing this but now we are having issues. I hope I made this clear and thank you for your help.
 
so what is taking place is the doctor is testing the drug to ensure the drug is still active in their system. once this is completed he sends this off to the lab and they check the quantity of what is in their system. The lab is sending in their bill first so they are getting paid first, what code should the lab be using? The doctor has a generic form that he uses to list the type of drug that is in their system and he sends that over as well to the lab. The lab is returning a lab report, how should we be reimbursed?
 
You really want to make sure you are understanding the doctors office part of the lab test being done. Normally a qualitative test is run in the office that gives a yes/no type answer to what drugs are in the patients system. This test is normally done with a dipstick or rapid test cup in which the appropriate code to bill is 80104 or G0431 for Medicare. This code can only be reported once because it is a multi test system meaning many drug classes are tested by one simple method.
Now if your office is actually testing each drug class individually for the qualitative result, then you bill 80101 for each drug class billed or G0431 for Medicare. So that being said if you tested 10 different drug classes individually you would bill 80101 x 10 for commercial insurance or G0431 x1 for Medicare.
By your description, it sounds as though you are doing qualitative testing via rapid cup - so you would only bill 80104/G0434 once.


Now - the lab is billing the quantitative portion of the test. Their testing shows exactly how much of the drug is in the patient's system and they are billling each drug code individually. For example, if they test opiates and Benzodiazepines they would report 83925 and 80154. but, if the lab the lab needs to send them out for a second confirmation by another laboratory, then the other confirmatory lab would bill 80102.

With work comp, I have found they do not want to pay for these tests, so it is always a good idea to get prior authorization first.

Hope this helps!

Caprice
 
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