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Medical Coding News Archives

New Billing Instructions for Qualitative Drug Analysis Testing

 
February 9, 2010:

Clinical diagnostic laboratories and other providers that bill Medicare for laboratory tests welcomed recent publications clarifying appropriate billing for certain tests.

The Centers for Medicare and Medicaid Services (CMS) published additional information regarding the 2010 annual update for the clinical laboratory fee schedule and laboratory services subject to reasonable charge payment. The article includes instructions for billing certain types of tests that are covered under Medicare and paid under on the clinical laboratory fee schedule.

The MLN Matters® article SE1001 provides instructions to clinical diagnostic laboratories for billing certain types of tests that are covered under Medicare and paid based on the clinical laboratory fee schedule. The article specifically addresses codes G0430, G0431, 80100, and 80101.

  • G0430 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
  • G0431 Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
  • 80100 Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
  • 80101 Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

Code 80100 describes a qualitative drug screen of multiple drug classes and must be performed by a chromatographic technique. An example of a common chromatographic technique for drug screening tests is thin-layer chromatography, which is performed by applying a thin layer adsorbent to a rectangular plate in the stationary phase. The specimen is applied to the plate, and the end of the plate is placed in a solvent. As the solvent rises along the adsorbent on the plate, the different components of the specimen are carried along at varying rates and deposited along the plate so the components can be separately visualized and analyzed.

Code 80101 describes a qualitative drug screen using a single drug class method such as immunoassay or enzyme assay. This screening test may be performed by a number of different methods, including simple drug screening kits that rely on immunoassay for detection of a single specific drug or drug class. For example, Placidyl (a.k.a. ethchlorvynol) can be screened in urine with a very simple colorimetric test where equal parts of urine and a single reagent are mixed and observed for a visual color change; this would be reported with 80101.

Based on concerns over questionable billing practices involving 80100 and 80101, CMS created two new HCPCS G codes (G0430, G0431). Code G0430 was created to remove the method restriction of chromatographic and to limit the billing to one time per procedure. Code G0430 is priced at the same rate as code 80100, and code G0431 is priced at the same rate as code 80101. Although the new code G0431 is a direct replacement for CPT code 80101, CMS has delayed this replacement until April 1, 2010; as a result, many laboratories are confused about how to bill for qualitative drug screening when the method used is chromatographic.

The following instructions apply during the period of January 1, 2010, through March 31, 2010:

  • For qualitative drug screening testing for multiple drug classes using chromatographic methods, report code 80100.
  • For qualitative drug screening testing for multiple drug classes that does not use chromatographic methods, report new code G0430.
  • For qualitative drug screening for a single class of drugs, regardless of the testing methodology, report the new code G0431.

Providers requiring a CLIA certificate of waiver should report code 80101 with the modifier QW, CLIA waived test, appended. (The Clinical Laboratory Improvement Amendments of 1988 [CLIA], requires appropriate certification of providers that bill Medicare for laboratory tests, and CMS publishes a list of tests considered to be waived tests under CLIA that require certification.)

CMS has promised to issue further direction and instructions for billing after March 31 by April 1, 2010. Additional information, the complete list of CLIA waived tests, and the official instructions issued by Medicare, can be found on the CMS website at http://www.cms.hhs.gov. The related MLN Matters® articles can be found at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1001.pdf and http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6657.pdf.

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical/Technical Editor

 

 
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