Health Information Management

Q&A: Why are we receiving denials for so many drug testing codes?

APCs Insider, February 20, 2015

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Q: We are receiving denials for many of the new CPT® codes in the laboratory section of the 2015 CPT Manual. We followed the mapping from the deleted codes to the new CPT codes, but we must have mapped something incorrectly.
A: You may have the new codes mapped correctly. However, CMS elected not to accept 28 new CPT codes for drug testing for 2015. Because lab codes are reimbursed under the Clinical Laboratory Fee Schedule for Medicare, CMS created HCPCS G codes to replace the deleted codes. The new G codes have the same descriptors as the deleted CPT codes and are assigned status indicator N (no additional payment, payment included in line items with APCs for incidental service) under the OPPS. The new CPT codes are assigned status indicator B (non-allowed item or service for OPPS) to indicate that there is another, more appropriate code to be reported under the OPPS. 
CMS provided a list of the deleted codes and a crosswalk to the new HCPCS G codes in Table 4 of Transmittal 3156.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question. Williams will be a presenter on the upcoming HCPro webcast, Reporting Tests in 2015 CPT's Overhauled Pathology and Laboratory Section, on Monday, April 27, at 1 p.m. Eastern. To attend, call 800-650-6787 and ask about product code YH042715.


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