Wiki G0483

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I have recently received 45 pre-payment medical records requests from Humana for G0483. Does anyone have any information on why and what needs to be documented in order to support G0483?
 
Looks like for CMS, you just have to have a specific code from their list. I would say the dx code has to be supported. Meaning if the dx is cervical spondylosis, there should be something in the record about the patient's back/neck problems. (I know you know that, but I'm doing an audit right now where they're just carrying over the problem list--they've got a lot of patients with M50 & M51 dxs but patients report no pain and exam is normal. That encounter isn't going to stand up to a RAC audit.)

 
G0483 - Drug test(s), definitive, utilizing (1) 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)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed, is a hot item for audit right now. It is frequently being overused or the documentation/physician's order for the test is lacking.

Also, some payers, including the one I work for, limit the number of times a year they will allow the G codes for drug testing to be covered.
 
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