# Pain Management and G0434/G0431



## suemt

Hi, all.  I'm having a 'discussion' with one of my doc's wives and she is adamant that they should be billing G0434 with 12 units for the 12 panel urinalysis drug screening they are doing for their chronic pain opioid patients.  And if that doesn't work, use G0431 with 12 units.  

I shared with her the LCD and CPT descriptions (any number of drug classes, per encounter), but she says there are new Medicare guidelines (2013) that say to bill multiple units for all the drugs they are testing for.  Of course, I could be wrong.  

Does anyone have a current reference on this issue?  Thanks in advance!

Sue


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## capricew

suemt said:


> Hi, all.  I'm having a 'discussion' with one of my doc's wives and she is adamant that they should be billing G0434 with 12 units for the 12 panel urinalysis drug screening they are doing for their chronic pain opioid patients.  And if that doesn't work, use G0431 with 12 units.
> 
> I shared with her the LCD and CPT descriptions (any number of drug classes, per encounter), but she says there are new Medicare guidelines (2013) that say to bill multiple units for all the drugs they are testing for.  Of course, I could be wrong.
> 
> Does anyone have a current reference on this issue?  Thanks in advance!
> 
> Sue





For 2013, the HCPCs book states that G0434 can only be billed once per pt encounter.  this means only one unit can be billed.  G0431 is also per patient encounter.  These codes can only be billed once per patient visit per day.  

My biggest question is what test are you really performing?  Are you doing a rapid cup test or dipstick that measures multiple drug classes with one test, or, are you performing each drug class individually in your office using a different reagent for each test?
If you are using the rapid cup test or dipstick then the appropriate code is 80104 or G0434 depending on your carrier.  
If you are testing each drug class individually with a separate reagent for each drug class tested then the code is 80101 or G0431 depending on the carrier.  
Medicare, Cigna, Aetna and BCBS all require the G codes.

Hope this helps


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## abs1821

We just had this issue come up...where can I find where this is stated that MCR, BCBS, Cigna and Aetna require this?  




capricew said:


> For 2013, the HCPCs book states that G0434 can only be billed once per pt encounter.  this means only one unit can be billed.  G0431 is also per patient encounter.  These codes can only be billed once per patient visit per day.
> 
> My biggest question is what test are you really performing?  Are you doing a rapid cup test or dipstick that measures multiple drug classes with one test, or, are you performing each drug class individually in your office using a different reagent for each test?
> If you are using the rapid cup test or dipstick then the appropriate code is 80104 or G0434 depending on your carrier.
> If you are testing each drug class individually with a separate reagent for each drug class tested then the code is 80101 or G0431 depending on the carrier.
> Medicare, Cigna, Aetna and BCBS all require the G codes.
> 
> Hope this helps


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## suemt

abs, you can usually find the Medicare info by searching for LCD's.  Here is a link to the LCD for qualitative drug testing.  

http://www.cms.gov/medicare-coverag...rch-results.aspx?Date=02/04/2013&DocID=L28145

For the other payors, you can often find this detail of information by searching their medical or reimbursement policies online.  Note that individual plans and appeals can override the overall policies, but the online policies are a good place to start.


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## capricew

abs,
for the other payers, Cigna, Aetna and BCBS, you will have to look up each of their individual policies for the urine drug testing and there you will find which code they want you to use.  
Our office received policy updates from those payers that we had to use the G codes after a certain date.  But, who knows, your state may have different policies.

Good luck!

Caprice Walder, CPC


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## vazq123

As of this quarter you can add United Healthcare and its subsidiaries/partners; Oxford, UMR, Harvard Pilgrim, etc ,to the list of carriers that also require 
G0434/G0431 for UDS.


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## HBROCKMAN

You can also add Cigna and the VA for wanting the G codes, maybe it's only here in Florida, but I do know they want it that way.

Here is another stumper for drug screens.  Our office just purchased an in office analyzer to run these drug screens easier and more efficiently than the cups (or so they were told by the sales rep).  Only now we come to find out that the code they gave us to bill for their machine, G0431, is considered upcoding by Medicare and cannot be billed by us....what????  Does anyone have any info on this..or maybe you have gone round and round in circles as I have.  I thought my days of researching which drug screen code to charge were long gone !

Here is the machine info in case this will help:
Thermo Scientific Indiko Plus with full automation

Thank you so much for taking your time to read this....even if you cannot answer...I am in the same spot right now...I have no answer!


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## bearybubba2008

HBROCKMAN said:


> You can also add Cigna and the VA for wanting the G codes, maybe it's only here in Florida, but I do know they want it that way.
> 
> Here is another stumper for drug screens.  Our office just purchased an in office analyzer to run these drug screens easier and more efficiently than the cups (or so they were told by the sales rep).  Only now we come to find out that the code they gave us to bill for their machine, G0431, is considered upcoding by Medicare and cannot be billed by us....what????  Does anyone have any info on this..or maybe you have gone round and round in circles as I have.  I thought my days of researching which drug screen code to charge were long gone !
> 
> Here is the machine info in case this will help:
> Thermo Scientific Indiko Plus with full automation
> 
> Thank you so much for taking your time to read this....even if you cannot answer...I am in the same spot right now...I have no answer!



I have the same question and I do feel your pain. Our office actually bought the equipment and also hired a part-time lab tech that runs the tests. Now our doc is mad because we are not getting paid as much as what the sales reps had said he would get paid.


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