Wiki Billing for Specimen Validity Testing

Create Wiki
A

alician

Guest
Messages
6
Best answers
0
Hello-

I'm receiving quite a few different responses from people within my company regarding billing for specimen validity tests - I work for a Tox lab, and several people are under the impression that you can't bill for it - however I have seen several claims be sent out w/ a pH/Specific Gravity code (83986) along w/ our Urinalysis code (81005) - both of which have been reimbursed by several different payers, including Medicare Part B.

Can someone please provide me with some insight on this issue? Or documentation from CMS that states we can/can't be doing this? Our office recently lost some key personell that would be able to handle this, and I am trying to fill in the gaps.

Thank you all so much!

Alicia
 
alician said:
Hello-

I'm receiving quite a few different responses from people within my company regarding billing for specimen validity tests - I work for a Tox lab, and several people are under the impression that you can't bill for it - however I have seen several claims be sent out w/ a pH/Specific Gravity code (83986) along w/ our Urinalysis code (81005) - both of which have been reimbursed by several different payers, including Medicare Part B.

Can someone please provide me with some insight on this issue? Or documentation from CMS that states we can/can't be doing this? Our office recently lost some key personell that would be able to handle this, and I am trying to fill in the gaps.

Thank you all so much!

Alicia
Click to expand...

If you read most payers medical polices on drug testing, they say that they will not pay for validity testing. The reason being that the results are not used in the management of the patient's illness, but rather they are used as a control by the lab. The feel it should be a cost of doing business rather than a compensable service. You may have gotten some codes paid, but that doesn't mean they won't reclaim the money if its discovered in an audit. Read through the following Medicare LCD published by Palmetto. See the "Non-covered services" section.

https://www.cms.gov/medicare-covera...ctr=379&s=53&DocType=All&bc=AggAAAIAAAAAAA==&
 
Last edited:
Hi Alician,

That is a great question. Specimen validity testing is a mandatory quality control measure that is integral to the process of drud testing. Most urine immunoassays have specimen validity checks built into the screening process. Validity testing is integral to the drug test process itself and is statutorily excluded from separate reimbursement. Urinalysis, pH, etc. should not be unbundled. Furthermore, if you read CMS code descriptions you would see the specimen validity question addressed.

G0480 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); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed
 
You must log in or register to reply here.
Top