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Help with Clinical lab billing

  1. Default Help with Clinical lab billing
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    We just obtained an account with a lab that does drug screens for abuse, quick history; We do billing for an outpatient drug abuse treatment center, they drug test the patients every other visit, they have an in house lab (that is structured as and considered a seperate entity) the lab performs urinanalysis for approximately 11 different substances, they have sent me a list of codes they bill for each but have a few questions that (never billing for a drug screening lab, I don't know the answers to) so I was hoping someone with this type of billing experience could help me.

    Here is the list they sent me stating that this would be what we would bill for each patient, and the few questions they are asking, all help is greatly appreciated!

    Amphetamines 82145
    Barbiturates 82205
    Benzodiazepines 80154
    Cocaine metabolites 82520
    Ethyl Alcohol 82055
    Methadone 83840
    Opiates 83925
    Quantitation of Drug NES 80299

    Questions;

    1. Can 83925 be billed only twice per day, per patient, they said they test for 3 or 4 drugs that would be considered opiates so how would we bill this?

    2. If a test result is unreadable due to the results being above the measureable range, they dilute and re-test, can they bill for the 2nd testing?

    3. Can we use 82101 for Buprenorphine?

    4. Can we use 82570 for Creatinine

    5. What would I use for THC? (80101)?

    Last question - How do I enter all this on a claim? each code as a seperate line item with the appropriate diagnosis pointer?

  2. Default
    First, when you say ;
    We just obtained an account with a lab that does drug screens for abuse
    are they performing the qualitative screening, whether it's cups or analyzer and sending the specimen to a toxicology lab for confirmations?
    Your other comment: never billing for a drug screening lab makes me think they may be.
    If all they are performing is the qualitative screenings, all that would be billable would be : 80101 x as many drug classes if they are being tested seperately or 80104 x 1 unit if they are getting the results from one test.


    The codes you listed:
    Amphetamines 82145
    Barbiturates 82205
    Benzodiazepines 80154
    Cocaine metabolites 82520
    Ethyl Alcohol 82055
    Methadone 83840
    Opiates 83925
    Quantitation of Drug NES 80299

    these are all confirmation codes to be used for quanitative confirmations. (performed using LS/MS/MC)

    1.Due to MUEs and methodology, the opiates (83925) are only billed once with 1 unit per day, per patient
    2. No
    3. the correct procedure code for Buprenorphine would also be 83925 (if it is performed usign LC/MS/MC), which would not be seperately billable; see answer to #1. (You can bill multiple lines of 83925 for each test and may even receive reimbursement, however, when the carriers do their annual audits, you will receive refund requests for each extra line billed)
    4. 82570 is for the validity testing of Creatine, but validity needs to be done prior to confirmation testing, so it is a component of and not seperately billable
    5. 80101 would be for a qualitative screening, 82542 would be the confirmation

    6. yes.....

    A OTPT tx center can have an inhouse "lab" with a medical director, however they still usualy only perform qualitative testing. I would confirm what or how their testing is being performed before billing anything.....

  3. Default 83925
    I do medical billing in a toxicology lab and we bill the 83925 with the 77 modifier all the time with more that on test being done on the same day. Are we doing this incorrectly if so please let me know and let me know where this information can be found so that I can take it to my boss and tell her it is wrong

  4. #4
    Default 80104
    If we are only using 1 specimen cup in the office and billing for POCT, would 80104QW x 1 be the correct way to code this for in office POCT UDS?

    Then when it is sent to the lab...they are billing 80101 for the # of drug classes (typically 14), running confirmation (80102) on each positive result per drug class and then further tunningqualitative tests on the positive results (Codes 82055, 82145, 82205, 80154, 82542, 82520, 83840, 83925, 82542, 83992, 82542, 82491, 82542)

    Does this sound about right?

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