Pathology/Lab Coding Alert

Question: We have a Medicare patient on pain management, and we performed a 12 drug panel, panel using diagnosis codes 356.9, V58.69, and 724.2. We billed 82570QW, 83986QW, 81003QW, 84311QW for the validation, and G0431 x 12 for the drug screen. For confirmation we billed 80102 x 12. Is this correct?

Illinois Subscriber

Answer: You should consider several comments regarding your billing.

1. You’ll have to use the ordering physician’s assigned diagnosis, which you describe as 356.9 (Unspecified idiopathic peripheral neuropathy), V58.69 (Long-term [current] use of other medications), and 724.2 (Lumbago).

2. If the physician orders a "validation" consisting of the following tests, then you should bill as you stated:

• 82570QW — Creatinine; other source. CLIA waived test
• 83986QW — pH; body fluid, not otherwise specified
• 81003QW — Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy

However, you also mentioned billing 84311 (Spectrophotometry, analyte not elsewhere specified) with modifier QW (CLIA waived test). This is not a waived test under the Clinical Laboratory Improvement Amendments (CLIA), so you should not bill this test with modifier QW. Also, this is a code for an analyte "not elsewhere specified," and you don’t state what the analyte is.

3. If the physician orders a drug screen of 12 drugs/classes as you mentioned, and your lab performs the screen using a high-complexity test method, then you should report the service to Medicare as G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter). You should not list 12 units of this code as you stated, because you should bill G0431 "per patient encounter," not per analyte.

4. If the G0431 drug screen identifies one or more drugs and your lab performs confirmation testing, you should report 80102 (Drug confirmation, each procedure). You should not report 80102 x 12 for each drug in the screening. Rather, you should report 80102 for each separate procedure you perform to confirm an identified drug. For instance, if you’re testing to confirm two drugs found in the screening and each requires a separate procedure, you should bill 80102 x 2. However, if your confirmatory test involves chromatography with only one mobile phase, for instance, you should bill only one unit of 80102 for the two drugs.