Pathology/Lab Coding Alert

Method and UA codes off the table.

After assigning seven, new HCPCS Level II “G” codes for you to report drug screenings in 2016, CMS has now created a host of edit pairs with those codes that you need to know about.

CCI 22.1, effective April 1, bundles each of the codes G0477-G0479 (Drug test[s], presumptive, any number of drug classes …) and G0480-G0483 (Drug test[s], definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers [but not necessarily stereoisomers], including, but not limited to GC/MS [any type, single or tandem] and LC/MS [any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)] …) with the same 17 CPT^® codes, as well as bundling many of the G codes with each other.

Read on to get a fix on when and how you can — or can’t — keep these bundles from impacting your bottom line.

Skip the Consult Codes

You should not bill the seven drug G codes with 80500-80502 (Clinical pathology consultation …), according to CCI 22.1.

Even if your lab report provides some interpretive language regarding the results of the lab test, that doesn’t count as a professional interpretation or consultation that justifies billing for an additional service.

Remember that codes 80500-80502 require a physician (or qualified health care professional) request in relation to a test result, a medical interpretation on the part of the pathologist, and a written report. If you meet those criteria for services in addition to the drug screening, which would be rare, you could override the edit pair by appending modifier 59 (Distinct procedural service) or other appropriate modifier to column 2 (consultation) code.

Don’t Expect Separate Validation Pay

When performing screening urine drug tests, labs typically perform validation testing to ensure that the specimen is urine, as well as using protocols to ensure that the specimen came from the patient. “You can’t separately bill for those validation steps,” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

That’s the reason for several of the new CCI edit pairs. Labs often use urinalysis (UA) (81000-81005, Urinalysis …) or creatinine (82570, Creatinine; other source), pH (83986, pH; body fluid, not otherwise specified), and protein (84156, Protein, total, except by refractometry; urine) for validation testing. Now you’ll find that CCI bundles each of those codes with each of the drug testing G codes.

Override: If the lab examines one specimen for a drug screen, such as blood, and the physician also orders a urinalysis on a separate specimen, you can bill for both procedures. Just be sure to append modifier 59 or other appropriate modifier to the UA code so you can get paid for the work. 

Avoid Double Dipping Methods

To test for specific analytes, labs use instruments that involve a fairly consistent array of test methods, such as immunoassay or chromatography. Many test codes are analyte-specific and possibly method-specific, and the drug-screen G codes are no different.

CPT^® also provides a few codes that describe just a lab method. You should use those codes if your lab tests for an analyte that doesn’t have its own code(s). But you should never list an analyte-specific code plus a separate “method” code for the same test.

That’s why CCI 22.1 bundles G0477-G0483, which are specific for drug analytes, with the following method codes:

• 82542 — Column chromatography, includes mass spectrometry, if performed (e.g., HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen
• 83516-83520 — Immunoassay for analyte other than infectious agent antibody or infectious agent antigen …
• 83789 — Mass spectrometry and tandem mass spectrometry (e.g., MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen
• 84311 — Spectrophotometry, analyte not elsewhere specified.

As with the urinalysis bundles, if the ordering physician requests a drug screen on one specimen and a separate test on a different specimen that is described by one of the method codes, you can override the edit pair with an appropriate modifier.

Pick One G Code — No Exceptions

In addition to the edit pairs with the 17 CPT^® codes discussed above, CCI 22.1 also creates the following column 1/column 2 edit pairs:

• G0478/G0477
• G0479/G0477
• G0479/G0478
• G0481/G0480
• G0482/G0480
• G0482/G0481
• G0483/G0480
• G0483/G0481
• G0483/G0482

Alert: CCI lists all of the preceding bundles between a G code and the 17 CPT^® codes with a modifier indicator of “1,” meaning that you can override the edit pair using a modifier, when appropriate. However, these G-code bundles “carry a ‘0’ modifier indicator, which means they can’t be bypassed with a modifier,” explains Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co.