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G0431

Marilyn Posted Tue 14th of December, 2010 01:37:26 AM

"G0431" Des anybody know how to bill AR Medicare with this code? I got some claims paid with 5units back in July, but now I am getting denials. I do get one unit paid.

SuperCoder Answered Tue 14th of December, 2010 03:36:33 AM

A qualitative drug screen may be indicated with a symptomatic patient when the history is unreliable, with a multiple-drug ingestion, with a patient in delirium or coma, for the identification of specific drugs, and to indicate when antagonists may be used. The clinical utility of drug screens in the emergency setting may be limited because patient management decisions are unaffected, since most therapy for drug poisonings is symptom directed and supportive.
Medicare will consider performance of a qualitative drug screen medically reasonable and necessary when a patient presents with suspected drug overdose and one or more of the following conditions:

Unexplained coma;
Unexplained altered mental status in the absence of a clinically defined toxic syndrome or toxidrome;
Severe or unexplained cardiovascular instability (cardiotoxicity);
Unexplained metabolic or respiratory acidosis in the absence of a clinically defined toxic syndrome or toxidrome;
Seizures with an undetermined history.
For monitoring patient compliance during active treatment for substance abuse or dependence.
A qualitative drug screen is medically reasonable and necessary for the monitoring of chronic pain patients in whom other illicit drug use is suspected.
Also, do check your State LCD policies to know more.

Pam Answered Wed 15th of December, 2010 03:04:22 AM

Alex,
I am currently working with a clinic on these codes. Where did you find this information about the conditions?

Pam

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