Health Information Management

Tip: Pay attention to CMS rules for reporting drug testing codes

APCs Insider, July 17, 2015

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In addition to extensive drug testing code changes in the CPT® Manual, facility reporting for drug testing also changed for 2015. All of the new CPT codes for presumptive and definitive drug testing have been assigned status indicator B (non-allowed item or service for OPPS).
 
However, an alternate code that is recognized by OPPS when submitted on Part B bill types 12x and 13x may be available.
 
In Transmittal 3156, the January update to the OPPS, CMS noted that laboratory services described by 2014 CPT codes that have been deleted will continue to be paid under the Clinical Laboratory Fee Schedule. CMS established HCPCS Level II G codes to replace these deleted CPT codes. These G codes have been assigned status indicator N (no additional payment) and mapped to the 2014 CPT codes in Table 4 of Transmittal 3156.
 
For example, a provider orders a test for alcohol in a patient's system. In 2015, coders would report CPT code 80301 (drug screen, any number of drug classes from Drug Class List A; by instrumented test systems). However, this code is not paid under the OPPS and doesn't crosswalk to a specific G code. Instead, coders should look to the 2014 equivalent, 82055, which crosswalks to G6040.
 
This tip is adapted from “Overhauled 2015 CPT drug test codes bring changes for coders and providers" in the July issue of Briefings on APCs.



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