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Anybody know??

  1. Default Anybody know??
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    I just rcvd a denial from a commercial payor on cpt code 80101QW for a date of service from last year. The denial states we can not bill this cpt code when the lab who did the confirmation billed them too. We bill for the screening part and send the urinalysis to the lab and they bill for the confirmation. Does anybody know how I can get these claims paid.??

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
    Default
    you cannot bill for the lab if you are sending it out to be analyzed. For your provider to perform a screening is part of the E&M

    Debra A. Mitchell, MSPH, CPC-H

  3. Default RGilmer w/an FQHC
    I agree. A CLIA waived (in house) lab should be billed with your OV. If you are sending it out, then you can't bill for it.

  4. #4
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    I disagree but would like to hear how you base your opinion. This is the second time I have heard this in the last few months. There is nothing I have ever seen that states that 80101 should not be billed with the sample is later confirmed by a reference lab.

    I work with several pain clinics that perform drug screens. Pt's who are selected to be screened are given a qualitative urine drug screen which is run through a table top analyzer (80101-QW x # of classes). The qualitative gives a fairly accurate immediate result. If the result is unusual or it is a new patient, the sample is sent to a reference lab for confirmation.


    More importantly....your reference lab shouldn't be billing for a qualitative test! This is a common scam with reference labs. Make sure you standing orders do NOT include a qualitative test.

    Your thoughts?

    Brock Berta, CPC

  5. #5
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    A quick follow-up to clarify:

    anggand@aol.com - Your claim is being denied as dup because the lab billed the code also...they shouldn't have.

    mitchellde - The screening is not part of the e/m. The office is paying $5 to $12 for the test kit and is allowed to be reimbursed for it.

  6. #6
    Default
    Quote Originally Posted by brockorama01 View Post
    I disagree but would like to hear how you base your opinion. This is the second time I have heard this in the last few months. There is nothing I have ever seen that states that 80101 should not be billed with the sample is later confirmed by a reference lab.

    I work with several pain clinics that perform drug screens. Pt's who are selected to be screened are given a qualitative urine drug screen which is run through a table top analyzer (80101-QW x # of classes). The qualitative gives a fairly accurate immediate result. If the result is unusual or it is a new patient, the sample is sent to a reference lab for confirmation.


    More importantly....your reference lab shouldn't be billing for a qualitative test! This is a common scam with reference labs. Make sure you standing orders do NOT include a qualitative test.

    Your thoughts?

    Brock Berta, CPC
    Once again Brock, I'd like to say... HELP!! lol... ok, professionalism....
    I thought that the QW modifier was only for use when billing to Medicare. Are you finding that even the commercial carriers are requesting this? I'm new to billing these code and I too work for anesthesia/pain management MD's. Any advice is appreciated. Feel free to contact me privately if preferred.

    thanks,
    Angie

  7. #7
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    Technically the QW is only for Medicare, however, most commercial carriers seem to request it. I bill the QW to all payers. It doesn't interfere with the billing process.

    Brock

  8. Default
    I disagree but would like to hear how you base your opinion. This is the second time I have heard this in the last few months. There is nothing I have ever seen that states that 80101 should not be billed with the sample is later confirmed by a reference lab.

    I work with several pain clinics that perform drug screens. Pt's who are selected to be screened are given a qualitative urine drug screen which is run through a table top analyzer (80101-QW x # of classes). The qualitative gives a fairly accurate immediate result. If the result is unusual or it is a new patient, the sample is sent to a reference lab for confirmation.


    More importantly....your reference lab shouldn't be billing for a qualitative test! This is a common scam with reference labs. Make sure you standing orders do NOT include a qualitative test.

    Your thoughts?

    Brock Berta, CPC


    Hi Brock, since the labs are only performing confirmation, shouldn't they be billing 80102? I would probably take this up with the lab billing supervisor. Hope this helps!

    Regards,

    Lisa

  9. #9
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    Don't believe so. The difference lies in the type of confirmation. The 80102 is a qualitative code. Qualitative tests can be done in a physician's office. The results are only positive or negative. Quantitative confirmations require actual numbers and require a gas chromatography mass spectrometer. Only the physician should bill for the qualitative. The point is the reference lab shouldn't also.

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