Author Topic: What is the difference between 80101 & 83518?  (Read 5817 times)

diagnostico

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What is the difference between 80101 & 83518?
« on: March 09, 2013, 01:48:37 PM »
Can someone tell me what the difference is between 80101 & 83518?
thanks for your help.

RichardP

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Re: What is the difference between 80101 & 83518?
« Reply #1 on: March 09, 2013, 05:11:01 PM »
http://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/subjecttoclia.pdf

Open that link into a new window;
Right-click on the page that comes up
Left-Click on "Marquee Zoom"
Left-Click on page several times until you can read it.

Right-click on the page
Left-Click on "Find" (box opens in upper right of screen)
Type in the code you want.

I could type the definitions for you out of the CPT manual, but they are copyrighted by the AMA.  Not sure if we are allowed to quote copyrighted stuff here.

You might also make the following link a Bookmark or Favorite.

http://www.google.com/

Open that link and type in either 80101 + cpt  or  83518 + cpt .  Some of the links you will find there may provide the insight you are looking for.  Here is one such link:

http://www.supercoder.com/my-ask-an-expert/topic/80101-vs-80104

diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #2 on: March 09, 2013, 05:16:01 PM »
RichardP,
what i read was that both codes are for immunoassay testing. that confused me.

diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #3 on: March 09, 2013, 05:23:23 PM »
the 83518 code is for immunoassay testing of dipstick.

all of the reimbursement reports that I have read show 17 test units of 80101 (12 drug panel + 5 adulterants) and 4 test units of 83518. What does this code actually represent? I'm not sure of where the 4 units came from.
see the attached reimbursement report

diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #4 on: March 09, 2013, 05:26:10 PM »
is there a definitive guide for why certain codes are used and how to determine the number of units billed for?
any help would be appreciated.

RichardP

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Re: What is the difference between 80101 & 83518?
« Reply #5 on: March 09, 2013, 05:53:56 PM »
diagnostico - could you elaborate a bit on your job / position.  I am assuming you work for the laboratory rather than for a doctor.  Is that correct?  Do you have access to a current CPT manual?  What is your responsibility?  Are you responsible for making sure that the doctors have asked for the proper tests?  Do you perform the tests?  Are you the biller for the lab?  For the doctor?  The answers to these questions would help us understand what training you have been exposed to, so that we can tailor our answers to your level of understanding.

80101 is for testing the presence of different drugs in the system [edited from blood], for a single class of drugs.

83518 is testing for indicators in the system [edited from blood] that the patient has a disease (e.g. diabetes) or for the presence of infectious agents.

They are not testing for the same thing.

The following link is not directly related to your question, but it is something you should know, if you don't already.

http://www.alfascientific.com/wp-content/uploads/2010/04/Reimbursement-FAQs-Jan.-2011.pdf
« Last Edit: March 10, 2013, 05:35:39 PM by RichardP »

diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #6 on: March 09, 2013, 09:47:34 PM »
RichardP,
I work with a startup clinical laboratory and am working in the billing department and trying to make sense of it all. I have ordered a cpt manual and am awaiting it's arrival.

The doctor's send in the urine samples from the 12 panel POC testing done in their offices (CLIA waived cup  http://www.ebay.com/itm/Waive-RT-12-Panel-CLIA-Waived-Drug-Test-w-5-Adulterants-Lot-25-/170949961007#vi-content) .

The docs bill 80101QW for the in office testing.
When we get the sample, we then bill only WC and PIP for New Jersey. Here are the codes that I have determined to be involved in the laboratory billing.

80101
83518
80299
83925
83805

The attached report that I have included above in the previous post is one of the reports that my manager has given me as an example of reports that he had from his previous position and asked me to make sense of it.

Is there a definitive guide to urine drug screen billing? Something concise and to the point that instructs me on which codes to use and when to use them for UDS?

thanks again for your assistance.

RichardP

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Re: What is the difference between 80101 & 83518?
« Reply #7 on: March 10, 2013, 12:19:33 PM »
Is there a definitive guide to urine drug screen billing?

Short answer:  not that I am aware of.

The regulations and codes surrounding reimbursement for drug screening have been changing in the last few years, and will probably continue to change.  Any guide would probably be outdated soon after publication.  That is why I provided you the links I did.  It will give you a head start on figuring out where to look on the internet to plug into the ongoing conversation about these changes.  Here is one more link, plus a repeat of the link in my last post.  Read through both carefully to see if you already know / understand what they are both saying.

http://www.supercoder.com/my-ask-an-expert/topic/urine-drug-screen-1

http://www.alfascientific.com/wp-content/uploads/2010/04/Reimbursement-FAQs-Jan.-2011.pdf

This link also speaks to the concerns you have voiced:

http://pathologyblawg.com/pathology-news/pathology-vendors/ameritox/urine-drug-screen-revenue-up-19164-in-ca-workers-comp-cases-in-8-years/

Finally - read through all of the links I provided in my posts above.  The responses you provided to my posts suggest you haven't absorbed the information in those links (there are some codes in those links that I don't see in your list).  Google on specific drug CPT codes as I suggested above.  Google on "urine drug screen" + billing (include the quote marks) and read through any resulting link that seems related to your questions.  I would also suggest Googling on "urine drug tests" + "workers compensation" + "name of your state" to see what comes up.

You need to educate yourself from various sources.  There is no one source that will answer all your questions.

Note:  I said elsewhere that my clients (who have POLs) don't do much clia-waved testing.  In fact, they do no clia-waived testing.  My clients collect the samples, but any clia-waived testing the patients might want are sent to outside labs.


diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #8 on: March 10, 2013, 05:03:30 PM »
richardp,
thanks for your help and patience. i have read the links previously as you have advised. i am just trying to make sense of it all so i apologize for the repeat questions. your help has been very insightful to say the least. in the report attached in the above message, the 83518 code was used 4 times. i did not create the report...it was handed to me. so i was trying make sense of it. this is from a wc patient in pa for a uds.

my research on uds does not reveal the use of 83518 for urine..only blood. so i was very confused. sorry again for the related question.

from your experience, why would any lab bill a wc payor for 83518 on a uds?  the report above was was part of an eob that was reimbursed for those codes.... so the payor was ok with the use of the blood related code on a urine test???????

under what conditions would a lab bill 83518 4x on a uds?


RichardP

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Re: What is the difference between 80101 & 83518?
« Reply #9 on: March 10, 2013, 06:21:24 PM »
I am just trying to make sense of it all ...

You and everybody else.

Quote
... my research on uds does not reveal the use of 83518 for urine..only blood. so i was very confused.

When you get your CPT Manual, you will see that the 80101 code and the 83518 code are listed under two separate headings.  Both codes can be used for testing urine, but the 80101 relates to testing for the presence of drugs in the body and the 83518 relates to testing for the presence of disease or infectious agents in the body.

Quote
... from your experience, why would any lab bill a wc payor for 83518 on a uds?  the report above was was part of an eob that was reimbursed for those codes.... so the payor was ok with the use of the blood related code on a urine test???????  Under what conditions would a lab bill 83518 4x on a uds?

So far as I know, the 80101 and 83518 codes are to be used in conjunction with CLIA-waived urine tests.  In reading my post from yesterday at 5:53 p.m., it ocurred to me that someone could interpret my statement to be about blood tests - so I changed the word from blood to system.

Why use 83518 in conjunction with 80101?  I know that certain drugs, when abused, can damage the liver and kidneys.  I know also that certain needles, when shared, can transmit HIV and Hepatitis.  So - if I'm testing for the presence of drugs, I might also want to know if the drug use has resulted in any damaged organs or the presence of infectious disease.  The 80101 code would be for the drug test and the 83518 code would be for the damaged organs or infectious disease test.

Let's make this personal.  You suspect I am on drugs, so you take me to the doctor for a drug test.  The doctor detects heroin by-products in my urine and suggests to you that you might want to know if I have gotten HIV or Hepatitis from my needle use.  You agree, so he sends the sample to the lab to test for damaged organs and infectious agents.  Doctor bills for 80101 and lab bills for 83518.  Or doctor bills for both.  Or lab bills for both.  But doctor and lab should not both bill for the same code for the same patient for the same date of service.

Testing for drugs in the system, and testing for organ damage and infectious agents that might have resulted from that drug use go hand in hand.

RichardP

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Re: What is the difference between 80101 & 83518?
« Reply #10 on: March 10, 2013, 09:34:24 PM »
under what conditions would a lab bill 83518 4x on a uds?

When you have the time, I suggest reading through this link, including the comments at the end.  This is about Medicare billing for CLIA-Waived labs, but it might give you some insight re. what is going on at your lab.  The exchange in quotes below from the comments at the link might explain the 4x question you have.  Commercial Carriers tend to mimic Medicare regulations, so perhaps Workers Comp in your state has done that - or the previous biller was presuming they had.

http://news.aapc.com/index.php/2010/04/changes-to-tests-clia-for-medicare/

Just spoke to my supplier of cups/strips, he states that as of July 1 [2010] CMS lowered aloowed units from 9 to 4, I will be sending all future claims as G0431X4 and see what happens. We do not test acohol. so Iím not sure if it will work like that or not.

Does anyone have documentation from CMS directly on the reimbursement being lowered from 9 drugs to 4 drugs?

No, no documentation, just word of mouth. :(

No, no documentation directly from CMS.

There is no documentation from CMS. Itís a question of trial and error. We talked to CMS and they said they would not publish how to get reimbursed for more than 4 units but it is possible. Most of this can be avoided by upgrading your lab from CLIA waived to Mod Complex and using an analyzer. No more cups, strips, or you follow a specific protocol everyday. It makes your whole drug testing program more legit. You should be doing at least 200 tests/month to make this a smart business decision for the practice.

diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #11 on: March 15, 2013, 03:27:10 PM »
richardp
thanks for the very thorough response. with a standard 12 panel drug screen why would a laboratory bill 83518 x 4?
that is my last question... i promise.

RichardP

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Re: What is the difference between 80101 & 83518?
« Reply #12 on: March 15, 2013, 06:22:56 PM »
[Edit]  In my response below, I was focused on the x 4 part of your question.  In re-reading it, I'm wondering if you are asking why is 83518 x 4 paired with a standard 12-panel drug screen?  I answered that question in the post above that ends with this statement:  Testing for drugs in the system, and testing for organ damage and infectious agents that might have resulted from that drug use go hand in hand. ...  The 80101 code would be for the drug test and the 83518 code would be for the damaged organs or infectious disease test. [/Edit]
-------------------

The allowable billing behaviors for CLIA-waived testing is pretty much controlled by CMS, and the commercial carriers often follow what CMS does.  The allowable billing behavior is pretty much in flux right now, as CMS grapples with new types of CLIA-waived tests that come to market.  They are trying to balance ease-of-use for the patients against ease-of-fraud for the fraudsters.

Billers could bill XXXX x 12 only because CMS allowed it, not because it was a god-given right.  CMS is now only allowing XXXX x 4.  Please re-read the italicized part of my last post, and read through the comments at the link that that quote came from.  So far as I know, there is no other answer than that.  And I already gave it to you.  And your final question suggests that you didn't read my response above ;).

Does anyone have documentation from CMS directly on the reimbursement being lowered from 9 drugs to 4 drugs?

No, no documentation, just word of mouth. :(

There is no documentation from CMS. Itís a question of trial and error. We talked to CMS and they said they would not publish how to get reimbursed for more than 4 units ...


Does that answer apply also to Code 83518?  I don't know.  And CMS is likely not going to tell you.  In this instance, and in too many others, it is a question of trial and error, of do it, and see what happens.  And what happens in once instance may or may not be what happens in the same instance later.
« Last Edit: March 15, 2013, 06:45:26 PM by RichardP »

QueenAlicia

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Re: What is the difference between 80101 & 83518?
« Reply #13 on: March 19, 2013, 10:26:57 PM »
I know that when I did consulting work for a lab we used the Medicaid guide.  Depending on the state you may only be able to bill 1 unit per code.  For example, the state of PA will only allow you to bill 1 unit per screen regardless if 12 or 16 screens have been tested.  I used the medicare and medicare sites to help with billing.

diagnostico

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Re: What is the difference between 80101 & 83518?
« Reply #14 on: March 30, 2013, 11:36:58 AM »
RichardP and Queen Alicia,
thank you so much for your feedback.