Health Information Management

Q/A: HCPCS code G0431 and multiple quantities

APCs Insider, February 4, 2011

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Q: We had been receiving line item denials for HCPCS code G0431 when we reported multiple quantities. However, our claims processed without incident in December 2010. Did something change?

A: Yes, the definition of G0431 has changed. CMS replaced CPT® code 80101 with HCPCS code G0431, including “for each drug class” in the definition, in 2010. In the original HCPCS code update for CY 2011, CMS redefined this code by specifying “per patient encounter."

CMS published a HCPCS code errata for the G codes January 19 that once again changed the definition. The most recent update of this definition is “Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter.” For CY 2011, this code may be reported once per specimen.

Access the errata file at “G-codes January 2011”.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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