Health Information Management

Q&A: Reporting drug codes with no G code crosswalk

APCs Insider, May 8, 2015

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Q: I have a question about reporting drug tests to CMS for CPT® codes that do not have a crosswalk to the HCPCS G codes CMS introduced. For example, which code should we report to Medicare for code 80321 (alcohol biomarkers; one or two), which is assigned status indicator B (non-allowed item or service for OPPS) and has no G code on the crosswalk?
A: In the 2015 CPT Manual's table of Definitive Drug Classes, codes 80321 and 80322 (alcohol biomarkers; three or more) are defined as including ethanol conjugates, ethyl sulfate, and fatty acid ethyl esters, all of which are metabolites of ethanol. HCPCS code G6040 would be appropriate to report, as it is defined as “alcohol (ethanol), any specimen except breath.”
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question. For more information, see the HCPro webcast "Reporting Tests in 2015: CPT's Overhauled Laboratory Section."

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