Health Information Management

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

APCs Insider, July 17, 2015

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

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.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular