Wiki HELP!!! Can any help me with billing G6058?

[rogeje]

Per CMS guidelines when billing G6058, it should include short string text to delineate which drug is being tested, for example to bill for Alcohol you would bill G6058 with the short string text ALC, and any subsequent drugs you would bill G6058 -91 with the short string text that corresponds with the drug. My colleague thinks that over use of -91 will cause reason for audit. I have included the links with the information from CMS. If you have any input and can give us a clear answer please respond.

http://www.cms.gov/medicare-coverag...t+B)&DocType=Active&LCntrctr=233*1&IsPopup=y&

http://www.cms.gov/medicare-coverag...t+B)&DocType=Active&LCntrctr=233*1&IsPopup=y&

 

[marvelh]

This coverage policy Article is specific to those states covered by the Palmetto jurisdiction - South Carolina, North Carolina, Virginia and West Virginia.

Other Medicare jurisdictions have not adopted these billing requirements.

The Palmetto A53951 article directs labs in their jurisdiction to:

Since G6058 does NOT identify the specific drug tested, test providers must report one service per ordered drug test per claim line and provide additional information to identify the drug(s) for each drug test ordered. ...
Use modifier 91 to indicate the additional G6058 or 84999 tests are not duplicates.​

 

[marvelh]

Also be aware that the Palmetto article requires use of a single line itme of 84999 if definitive testing is performed on 8 or more drugs, rather than billing each of the individual drugs:

When a physician determines profile testing that includes eight or more definitive drugs is medically necessary, submit CPT code 84999, one (1) UOS, and CSPAN in the SV101-7 field adjacent to the CPT code