Medical Billing Forum

Coding => Coding => Topic started by: CMorgan on December 18, 2015, 07:47:41 PM

Title: UA Drug Testing/Screening
Post by: CMorgan on December 18, 2015, 07:47:41 PM
When do I use code G0434 vs. H0003 for a low complexity UA? How do I know what payer accepts what code? Are there any other codes for Low Complexity UA's?

What are some codes for High Complexity UA's? Is G0431 good for this? Some payers do not accept the 80300-83992's codes.
Title: Re: UA Drug Testing/Screening
Post by: Michele on December 20, 2015, 04:36:43 PM
You need to use the code that most accurately describes the service that is being performed.  Be careful not to "Code to get paid".  Of course all providers want to be reimbursed for their services however it is fraudulent to code specifically to get paid. 

The H0003 is Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs.

The G0434  is for Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter

The G0431 is for Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

You need to pick the one that describes the testing being done.  I believe Medicare only reimburses the G0431.

Some payers prefer certain codes to report drug screening but that should be in your contract (if you are in network).

I hope this helps.