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G0431

Sylvia Posted Fri 27th of September, 2013 11:08:38 AM

MY LAB TEST HIGH COMPLEXITY, DO I BILL MULIPLE UNIT(S)

SuperCoder Answered Fri 27th of September, 2013 18:09:33 PM

The correct code depends on the complexity of the test you perform, not on your CLIA certification level (assuming you're approved for the level and type of test you perform).
Immunoassay drug screens can be moderate or high complexity, depending on the manufacturer and/or instrumentation. For the work you describe for Medicare coverage, you should report one of the following codes depending on the complexity of the test:
G0431 -- Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter G0434 -- Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter
Watch reimbursement: You don't want to make n $82 mistake by billing a high-complexity test as a moderate complexity test. Medicare pays $102.99 for G0431, but only $20.60 for G0434 (2012 Clinical Laboratory Fee Schedule national limit amount).

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