Thanks to CMS's surprising 2011 reversals many coders are finding themselves in a fix. Know how to g

Many lab coders are confused now, owing to the 2010 code changes and CMS's surprising 2011 reversals. Don't be. Here, we'll show you the way on ways to get all the pay you deserve for Medicare drug screening tests.





Your choice is ruled by complexity





If your lab carries out drug screening for single or multiple drug classes by any lab method other than chromatography, you have two options to report your work for Medicare beneficiaries this year:





G0431 (revised) and G0434 (new)





You should choose between these codes based on the Clinical Laboratory Improvement Amendments (CLIA) complexity classification of the specific lab test you are using. The CLIA categorizes tests into three complexity groups, as follows:

Waived tests

Tests of moderate complexity, including the subcategory of provider-performed microscopy (PPM) procedures

Tests of high complexity.





You should report only one unit of G0431 or G0434 per patient encounter, irrespective of the number of drug classes you detect.

Chromatography brings in mixed signals





In spite of pricing 80100 on the CLFS, the Medicare Physician Fee Schedule (PFS) lists 80100 with an 'l' (invalid) code status indicator. This means the code is "not valid for Medicare Purposes. Medicare makes use of another code for reporting of, and payment for, these services.





In comparison, when Medicare makes the payment for a code on the CLFS, you will see the code listed on the PFS with status indicator "X". This means the code may be paid on a different fee schedule, such as the CLFS, since the code represents a service that's not in the statutory definition of 'physician services'"





Other codes won't bring you the payments





Most likely you used G0430 for some drug screen tests last year, however CMS deletes the code for this year. This year's CPT adds a new code with the same definition – 80104. The intention was for Medicare to accept the new CPT code in place of G0430.





Surprise: The agency deleted G0430 as anticipated, but declined to price 80104 for Medicare beneficiaries. In its final payment determination for the Clinical Laboratory Improvement Amendments, the agency states that the 80104 code descriptor "doesn't precisely mirror the types of tests that need to be captured for accurate billing and reimbursement. In its place, the descriptor for G0431 has been edited, and new test code G0434 has been made.

To get the complete details, and for other information relating toHCPCS codes, sign up for a one-stop medical coding guide like Supercoder.