Billing > Billing
What is the difference between 80101 & 83518?
RichardP:
--- Quote from: diagnostico on March 10, 2013, 08:03:30 PM ---under what conditions would a lab bill 83518 4x on a uds?
--- End quote ---
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 I’m 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. It’s 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:
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:
[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. It’s 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.
QueenAlicia:
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:
RichardP and Queen Alicia,
thank you so much for your feedback.
Navigation
[0] Message Index
[#] Next page
[*] Previous page
Go to full version