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G0477; billing for quick read drug screens

  1. Default G0477; billing for quick read drug screens
    Medical Coding Books
    We are looking to use the Quick Read drug screen cups in two of our practices. Our cost is $8.20 per cup. We are looking to bill the G0477 presumptive code (visual read). We then send confirmation out to a company and then they bill (I assume G0480-G0483 for definitive reading).

    I was told that we should not be billing the presumptive visual read but how do we get reimbursed for the cost. Doesn't make sense to me.

    Need guidance if anyone has information. Are you also getting paid for the G0477? Is it worth it?

    Thank you for any assistance.
    Last edited by Kpetruso; 04-19-2016 at 12:46 PM.

  2. Cool
    Quote Originally Posted by Kpetruso View Post
    We are looking to use the Quick Read drug screen cups in two of our practices. Our cost is $8.20 per cup. We are looking to bill the G0477 presumptive code (visual read). We then send confirmation out to a company and then they bill (I assume G0480-G0483 for definitive reading).

    I was told that we should not be billing the presumptive visual read but how do we get reimbursed for the cost. Doesn't make sense to me.

    Need guidance if anyone has information. Are you also getting paid for the G0477? Is it worth it?

    Thank you for any assistance.
    We are getting paid by commercial insurances & some HMO's/MCO's.
    We've found that Paramount and Buckeye Health are allowing $0.00 for the code as it's a new code (to their system, not to 2016). We've been struggling with our optical urines for quite some time. G0434 will most likely cause a rejection at your clearing house level, so it is advised to bill your G0477 for 2016 claims, and get with the payer to determine whether or not your patient will need a prior auth for that code. We've seen the G0477 code reimburse at $75.00-125.00 depending upon the insurance company.

    Good Luck!!

  3. #3
    Default
    Considering G0434 is a deleted code for 2016, yes it will cause problems. Also for medicare the CLIA waiver status was not added to G0477 until April which would have caused issues as well for dates earlier this year.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  4. #4
    Default
    Quote Originally Posted by Kpetruso View Post
    We are looking to use the Quick Read drug screen cups in two of our practices. Our cost is $8.20 per cup. We are looking to bill the G0477 presumptive code (visual read). We then send confirmation out to a company and then they bill (I assume G0480-G0483 for definitive reading).

    I was told that we should not be billing the presumptive visual read but how do we get reimbursed for the cost. Doesn't make sense to me.

    Need guidance if anyone has information. Are you also getting paid for the G0477? Is it worth it?

    Thank you for any assistance.
    Whoever told you not to bill G0477 for the cup is misinformed. That is the correct code. You need to make sure your practice has a CLIA waiver, and that you append modifier QW.
    Walker Bachman, CPC, CPPM

  5. #5
    Default Still not getting paid for g0477
    Good Afternoon!

    I had heard that there was an issue with Medicare and getting this code paid until after April 1, 2016. I began holding all of these and waited until 4/6 and am now getting denials again!?!?! I can't figure this out.....if anyone is having success with this code?? I've tried everything....with and with out the QW, coding the pain dx plus the Z51.81 for drug monitoring and then just the Z51.81 alone, also tried the Z79.891. Also tried the 80300 for commercial.

    I am getting so frustrated!!! Can anyone PLEASE tell me if you're getting paid and HOW?? Exact diagnoses and whether you're using any other modifiers other than the QW!?!? I will be SOOOO appreciative!! Wasting so much time for not much money!

    Thank you! Have a great weekend!!

    Meghan

  6. #6
    Default
    MEGHAN,
    Ive tried the same. I learned not only does the clia number have to be in box 23 (yes prior auth box) but it has to come over through loop 2300 i believe if you are billing electronically. I called my billing software company and they set it up for me and now im just waiting to see if it goes through. Ill keep you updated if it pays!

    I now however, am having trouble with this with our local medicaid. but they are denying due to my place of service code, which is 11 for office. i try to call but get nowhere, anyone familiar with this?

  7. #7
    Default
    Meghan,

    I just checked one and it paid $14.86!! So I would definately just make sure you have the providers CLIA # in box 23 (preauth box) and check with your billing software of which loop to put it in, I believe it was loop 2300 they told me. I have also been working on this since January and its now June so Im very excited! We do about 20-30 of these a day in our office

  8. Default G0477 Qw modifier or no and what Dx
    Hi Ashley,

    For the ones that you have received payment on did you bill with the QW modifier? And what DX did you use?

    Thanks
    Any

  9. Default G0477
    My office is a Pain Management clinic and we use G0477 for our Point of Care cups. We are a Clia waived Facility so we have to bill a QW modifier with this. Also make sure that the Dx code F11.20 is linked to the code. Medicare pays $19.26 and commercial pay $22.00 for it.

  10. Question F11.10
    F11.10 suggests Opioid abuse. Is that what is going on? or is this random testing? Z79.891 used for long term current opioid use.

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