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I am not sure if anyone is having the same issues on er visits but we are billing 80307 and it is denying. Excluding medical necessity is there another HCPCS code that we need to change that will cover or anything else? Thanks in advanced.
Are you billing for the physician? its an automated lab that would be billed by the facility so that could be the reason. Its also not a CLIA waived lab so that is another explanation.
I am billing for an ER visit and some account didn't cover that code so we didn't get paid on it. I figured it wasn't clia waived and that makes sense. Just can't seem to pin point the problem.
I wouldn't expect ER physicians to bill for lab tests in general since its done using the Hospitals equipment. Its not considered a professional service as there is no PC/TC component. The work is billed for on the Hospitals UB claim.
But if the patient came into the ER for drug intoxication they will order a drug screen. They also do labs as well when it necessary. So if that CPT code is correct to code for ER visits I am not sure why it would be denying. Do hospitals use another code instead of 80307?
Physician in hospital will bill for services they personally performed, not what they order. The hospital performs the lab with their equipment, their lab techs and bill on the UB claim under Revenue code 030X. There is no professional component to be billed. The interpretation of the lab report is included in the E&M code.
Do you know any guidelines on this? I have been researching this issue online and haven't been able to find anything. So if a patient came into the ER for Behavior health and they ran a urine drug screen and the results were positive it should cover correct? Or does it depend on the payer.