# Physician Billing for Drug screens in 2016



## carlyjo82 (Jan 14, 2016)

I bill for a pain management office who routinely perform in office (cups) drug screening for patients on RX narcotic meds.  We would normally bill G0434-QW for such tests, but now I'm getting rejections for this.  I know CMS did away with this code and replaced with several others.  I started billing G0477-QW in 2016 and am still getting rejections and denials.  Can physicians still be reimbursed for in office drug screens in 2016, and if so, what is the appropriate code for the test?  Any guidance would help!  Thanks.


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## pfuhrer (Jan 18, 2016)

What do the denials say? We are also getting denials "claim is incomplete and/or invalid information." We are using G0477-QW, Dx code Z79-891.


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## carlyjo82 (Jan 18, 2016)

The claims are rejecting out of the payers clearing house when we bill electronically stating "HCPCS code is invalid".  I am using G0477-QW with Z79.899.  I noticed the new codes aren't on the Medicare Fee schedule either.  Its rejecting out of Medicare and Cigna electronically.


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## tba123 (Jan 19, 2016)

My vendor stated to code with dx Z79.899. However I think you may also need the actual clinical dx.  Make sure your clia number is going on the claim. And for medicare you are using QW modifier.


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## mitchellde (Jan 19, 2016)

If you patient is on therapeutic drug treatment and you are testing to assure compliance then it is not a screening, it is drug monitoring, so use the Z51.81 followed by the Z79 code.


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## carlyjo82 (Jan 22, 2016)

Thank you all for your help.  I should clarify that I'm not getting actual "denials" yet.  What's happening is G0477-QW is rejecting out of my electronic billing system by the payers clearinghouse stating that the code is invalid.  Its doing it for Medicare, Cigna and BCBS.  So for the commercial payers, I've been pushing them to paper and sending them in that way.  But I can't seem to get the Medicares to transmit electronically with that code.  I have tried changing the DX codes as well.  Any thoughts?


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## rdewitt (Jan 22, 2016)

Our offices are also having trouble billing G0477-QW, but we believe the issue is the QW modifier.  CMS did not attach a QW to the code G0477.  We have reached out to the regional CLIA office to see if they can help resolve the issue.


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## jgolden1976 (Feb 1, 2016)

*Horizon and blue Cross rejections*

Hello- We are seeing only horizon and BCBS rejecting the new 2016 Drug testing codes. We do not use the Modifiers QW on the G0479, G0480, G0481 G0482. We have no other rejections. We are only using Drug/Alc withdrawal coding on the DX such as F11.20 f13.20 etc.

Does anyone know for a fact the aBCBS and Horizon re not using the new Drug codes? I checked in the gudlines and policy updates and nothing showing that they are acceptnig or not accepting these code changes, yet they always seem ot follow CMS guuidelines.

Any input?


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## aweaver74 (Feb 4, 2016)

We were billing the G0434-QW but changed it after 1/1/16 due to it being deleted. We are now billing the G0477-QW and Medicare is denial these codes. When we called today the representative told us that these codes do not go into effect until 4/1/16. So what code do we use in the mean time?


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## CodingKing (Feb 4, 2016)

Nevermind, i interpreted the MLN wrong. see the following thread for similar discussion

https://www.aapc.com/memberarea/forums/132085-modifier-qw.html


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