Wiki Code G0434

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amanda.cosby3

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Does anyone use code G0434 for drug testing? With ICD 9 we used dx code V58.69 and Medicare paid. I am now using codes from Z79 but Medicare is now denying for medical necessity. Has anyone else ran into this or have any advice for getting the code paid by Medicare?
 
I am having the same issue. I checked the LCD and Z79.891 was what was recommended - but the corrected claims are being denied.
 
I called Novitas and they are manually resubmitting claims with service dates of 10-1-15 through 12-31-15 if you have a primary dx of Z79.891 and call in for claims correction. There has been a glitch with CMS requiring a second dx after Z79.891, but they never said what the second dx needed to be so all claims are being denied.
 
new code for G0434

I have searched for the new code but I'm having trouble finding the correct code. Can anyone suggest the appropriate code I should use? We use clia waived cups with dipstick. Thanks
 
The second missing dx may be the clinical diagnosis which is the reason they are on the drug that requires testing. Make sense, couldn't figure out how to word it properly, lol.
 
We use the Z51.81 first and then the Z79 code for the drug.. No problems with any payer. But not for G0434, sorry. That is a drug screen code you need a Z code for screening, I usually use Z13.89
 
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lcolburn said:
I have searched for the new code but I'm having trouble finding the correct code. Can anyone suggest the appropriate code I should use? We use clia waived cups with dipstick. Thanks
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Effective 1/1/2016, the new code that replaces G0434 is G0477 and is defined as: Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service. This code does not require a QW modifier per CMS's 2016 Clinical Diagnostic Laboratory Fee Schedule.

However, as for diagnosis, if you are using Z79.?, you must now "Code also" Z51.81 and vice versa. The "Code also" is noted within both of these codes. So, if you are not using both, this could be why your claims are getting denied. And then there is also what another member posted that CMS had a glitch in their system. (Their way of holding your office's money longer.)
 
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