Wiki Addiction medicine coding/reimbursement

[vbednaz2@gmail.com]

Good afternoon! Our family practice has a doctor who also sees patients with opioid addiction, as he has a sub-specialty in addiction medicine. 95% of these type of visits consist of an office visit (we bill a 99213 or 214, depending on the level for the visit) for routine follow up for pts that are on Suboxone, as well as a urine drug screen (80305 for a qualitative, read by the medical assistant) and a breath alcohol test (82075). Over the last year, we have seen fewer and fewer payers paying on the two tests, saying they are inclusive to the office visit. Medicaid is pretty much the only payer that pays. I'm wondering if there is some type of modifier we should be using or maybe if it's more of a diagnosis-driven issue? We do append the QW to the UDS since we are CLIA-waived. We've also used -25 modifier to show that it is a separately-reportable procedure. What am I missing? Or is it just how it is now? It seems that there should be at least minimal reimbursement for the supplies used outside of the office visit. Any input is appreciated

 

[SharonCollachi]

We stopped doing rapid tests in the office, as the results are neither accurae nor actionable. Meaning, we would send the urine out for lab results no matter what the point of care cup showed. If someone is positive for opiates, is it the opiate we prescribed or the opiate they got from a friend? POC cups won't tell you.

So I would consider stopping the POC cups and just send the urine out for testing.