# UDS billing to Workers Comp carriers



## asexton81 (Jun 24, 2014)

I work for a pain management office and we use a clia waived lab. We normally bill G0431 but are receiving denials when billing for Workers Comp. Does anyone know of a better CPT code to bill for this service to get paid by the WC carriers?


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## betsycpcp (Jun 24, 2014)

Possibly G0434 (drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter).


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## asexton81 (Jun 24, 2014)

Per the Fl workers comp bureau if there is a cpt code that describes the service then we can not use a HCPCS code. So there is another code but they would not tell me what it is. 
We were thinking 80101. Does anyone know if this is the correct code ?


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## betsycpcp (Jun 25, 2014)

80101 is more or less equivalent to G0431- may not be appropriate for CLIA waived, but you would need to go by the exact code description to determine that.  80104 may be it--a note in the CPT book (AMA version) under 80101 says qualitative analysis by multiplexed screening kit for multiple drugs or drug classes would be 80104.  
Here's a link with suggestions for Medicare and non-Medicare UDS coding:
http://blog.physiciansofficeresource.com/volume-7-issue-02/185/drug-screen-reimbursement


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## mssalemny (Jun 25, 2014)

80104  if it is the in house urine drug screen. If you send a confirmatory one to a lab they would be coding the 80101


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## asexton81 (Jun 26, 2014)

80101 is it, we don't do the testing in house. In my research I found the number to the State of Fl WC Division and 80101 was confirmed to be correct. 
Thank you for your help


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## marvelh (Jun 26, 2014)

80101 and G0431 would not be compliant to report for a CLIA waived test.  The codes to review would either be 80104 or G0434.

You don't do the testing in your office but are billing for it?? Is this purchased lab?  If so, you should consider appending modifier 90 to the drug screen testing coding so that it is clear that this testing was performed by an outside lab, not in your office.


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## asexton81 (Jul 7, 2014)

Thank you for the link

http://blog.physiciansofficeresource...-reimbursement 

It states _For practices using automated instrumentation to perform high-complexity qualitative or quantitative testing, billing and reimbursement is more complex.  The laboratory must have a CLIA Certificate of Compliance and (depending on your state) a state Clinical Laboratory License.
For Medicare use code G0431 and for non-Medicare use code 80101 times the number of drug classes being tested._

This is the rule for Workers Comp claims in Fl.


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