Wiki Urinalysis done in office

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stonecm

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Good afternoon. Worker's comp is denying 80100-QW stating "md office only took urine sample and transferred drug testing and billed for it. As the lab actually processed the testing, only the lab can bill for the testing. 80101 is inappropriately billed by the MD office as they did not actually process the drug test"

Our office did the drug screen in office using a CLIA. Does anyone have any experience in appealing these to worker's comp? Not exactly sure how to prove this was done in office other than the requisition form? Thanks in advance!
 
AMA Cpt Assistant Dec 10,

"multiplexed' because of the ability to qualitatively assay multiple drug simultaneously. It is effectively running multiple tests at once, in a single procedure, due to the test kit desing. Prior to 2011, the reproting was commonly reported as mutliple units of code 80101, as code 80101 was not specific to a single or multiple sequential procedures. In 2010, HCPCS code G0430 was created to describe a non chromatographic method wherein multiple drug classes were screened in a single procedure. New code 80104 more accuratley reflecting the resources used in a multiplex test kit as compared to multiple runs using a single class methodlogy.

AMA CPT Changes 2011

Code 80104 has been established to report a specific drug screen, qualitative analysis by multiplexed method for 2-15 drugs or drug classes (eg, multidrug screening kit). The existence of CPT codes and HCPCS Level II codes reportable in 2010 for drug testing created confusion regarding appropriate reporting of qualitative drug screen testing and imposed additional administrative burdens on providers. Code 80104 has been established to report qualitative analysis drug screen by multiplexed method. A cross-reference has been added following code 80101 to direct the user to 80104. Code 80104 appears with a number symbol () to indicate that this code appears out of numerical sequence...
 
W/c uds

We have had success in getting paid with G0434-QW in the past when we were still a CLIA waived testing provider. These were billed out under the physicians ID.
 
Give them a copy of the results

I work with many WC carriers. They want the actual number of tests done. make sure the Doc is dictating the results in his/her note.

I had the same issue a couple months ago where the Doc was only stating one positive and they would only pay for the one test.
Always make sure its documented in the note.
 
If you are reporting per single drug class with 80101, this type of testing would t be performed by instrument that would be individually testing per drug class. In this type of situation you would have a formal report that would support the results of the drugs tested. The drugs that are going to be tested can be listed on the order form that the physician fills out which indicates which drugs he feels needs to be tested. But I think the important point is not to confuse point of care testing with drug test kit performed in a physician office which is reported with 80104/G0431 with one unit compared to testing that is high complexity G0431 or 80101 that testing done per drug class.
 
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