Wiki UDT with Screen & Confirmation

[robertjsenese]

Good morning,
The clinical laboratory process is: when they receive a UDT,

1.) run it through an analyzer for a +/- result on 13 drugs (and validity)
2.) take the specimen and then run it through a Mass Spec for definitive result on drugs that are abused but not recognized on the analyzer (i.e. synthetic cannaboids, alcohol metabolites, etc.)

My question then is, is it acceptable to bill for the presumptive/qualatitive screen,
with G0431/80301
and then bill for the definitive profile from the confirmation test.

or should be only be billing for the confirmation.

thank you.

 

[robertjsenese]

"A presumptive test may be followed by a definitive test in order to specifically identify drugs or metabolites."
AMA, CPT 2015, page 467

Okay, so i answered my own question,
it is acceptable using modifier 59.

However, to be reimbursed on both services, can they be on the same day?
or should the presumptive test be done on day 1, and the definitive test be done on day 2?

thank you

 

[Cavalier40]

Here is the way I understand it.

The individual mass spec test for a specific metabolite (quantitative) can be done on panels recognized by a table top qualitative analyzer if there is a positive result, or if you are testing for a panel not in the qualitative test.

We have a 19 panel table top in which we bill the G0431 (the swtich to per encounter has been horrible.) then we send all of the samples to another lab for confirmation in which they test 3 additional panels and the metabolite for positive results from our machine. The other lab got into audit trouble for confirming all panels without a positive result.

I do not know what DOS they put on their claims, but we do get from time to time get PTP FEP EOBs (since we are non par with BCBS) sent to us and it appears they are using the specimen collection date (like we do). However I am not sure if having both the qualitative and quantitative machines in the same lab changes anything. So the 59 modifier might need to be added.

This probably is not helping, but I do know that G0431 and 80301 is for different lab classes using 2 different methodologies. So both codes can be used.