Drug Testing Codes for 2015
For most of my career as a Laboratory Medical Technologist, I worried about the integrity of the specimen I was testing and the accuracy and timeliness of the results. It wasn’t until I began to transition to laboratory management that I even knew about procedure codes. And with the first OIG Compliance Guidance, which was for laboratories of course, there came even greater knowledge and concern for the correct reporting of procedure codes. But even after years in healthcare compliance, accurate procedure code selection is not getting any easier. And for 2015, the challenge continues…
This is Medical Laboratory Professionals Week and MMP would like to acknowledge the hard work and dedication of laboratory professionals whose expertise is needed in the performance of laboratory testing. According to the American Society for Clinical Laboratory Science (ASCLS), “There are approximately 300,000 practitioners of clinical laboratory science in the United States. Since the development of this career group in the 1920s, the clinical laboratory science professional has played an increasingly vital role in the diagnosis and prevention of disease. Today, the clinical laboratorian is a key member of a health care team.”
The biggest challenge related to billing and coding for the clinical laboratory this year has definitely been the numerous CPT and HCPCS code changes for drug testing for 2015. The details of all the changes are quite complex and a lot of the confusion relates to differences in CPT codes and the HCPCS codes that Medicare requires. A summary of the major changes are:
- CPT created new drug screening codes (presumptive testing) based on testing methods for two different drug “lists”
- CPT 80300 – Drug Class List A, direct optical observation, per date of service
- CPT 80301 – Drug Class List A, automated analyzer by immuno- or enzyme assay, per date of service
- CPT 80302 – Drug Class List B, each procedure
- CPT 80303 – Thin Layer Chromatography (TLC) , per date of service
- CPT 80304 – other screening testing methods, each procedure
- Medicare maintained use of current HCPCS codes for drug screening
- HCPCS G0431 – drug screening by high complexity methods, per patient encounter
- HCPCS G0434 – drug screening by waived or moderate complexity methods, per patient encounter
- CPT deleted a number of therapeutic and chemistry drug assay CPT codes and replaced them with new definitive drug testing codes (CPT codes 80320 – 80377). These codes are only to be reported for complex testing methods and are not for drugs tests performed by immunoassay or enzyme assay.
- Medicare is not accepting these new definitive CPT codes but instead created new HCPCS codes to replace the deleted CPT codes. These new HCPCS codes (G6030 – G6058) are to be used based on the same instructions that applied to the deleted 2014 CPT codes they replaced.
Another challenge related to the new drug testing codes is determining which codes should be reported to commercial insurances. Blue Cross Blue Shield of Alabama recently released a new coverage policy for Urine Drug Testing in Pain Management that states:
“Blue Cross and Blue Shield of Alabama has adopted the revised coding position articulated by CMS. Use of CPT codes 80300-80304 are not reimbursed separately. G0431 or G0434 should be billed for urine drug screen testing. One unit of either code (G0431 or G0434) will be reimbursed per encounter if the above criteria are met. Use of CPT codes 80320-80377 are not reimbursed separately and the appropriate corresponding G codes (G6030-G6058) should be billed for quantitative/confirmatory testing.”
A review of other commercial insurance policies around the nation revealed a wide array of coding requirements. Most appeared to accept either CPT codes or the Medicare screening HCPCS codes (such as Capital Blue Cross which serves central Pennsylvania), although there were some policies like the BCBSAL policy that specifically required the Medicare-accepted HCPCS codes (Blue Cross and Blue Shield of Oklahoma) . Some commercial insurance drug testing coverage policies have been updated to address the 2015 coding changes and some have not. For example, South Carolina Blue updated their policy in July 2014 and required the Medicare screening codes and the CPT confirmation code that is now deleted – I could not find a more recent revision, but providers more familiar with their website may be able to. Bottom line, providers should check with the commercial insurance companies they bill to determine which drug testing codes the payer requires.
Selecting the correct procedure codes for drug testing for 2015 is definitely a challenge. To understand the different testing methods, hospitals must have clinical input from a laboratorian. The next step is determining whether a specific payer accepts the CPT codes and/or the HCPCS codes. Then, hospitals will have to make sure the correct codes get on the claim for the specific payer. All of this work and then payment is either packaged (Medicare) or probably not a large reimbursement amount. As I said at the beginning, the challenge continues…
Article by Debbie Rubio
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.