Marie Posted Tue 25th of January, 2011 17:15:59 PM
Workers comp no longer recognizes 80101qw, or G0431qw. There is a payable code but WC won't tell what it is. Having trouble finding. Anyone know? Thanks for the help
SuperCoder Answered Tue 25th of January, 2011 22:16:26 PM
If a service that is a performed by the Lab is not covered under your CLIA certificate you can not bill the patient for this service and these codes will be billed with Modifier QW. The claim must also have the correct CLIA number on the claim to be billed.
On February 5, 2010, CMS released Transmittal 1905, and thereafter, on March 19,
2010, CMS released Transmittal 653/Change Request 6852 which, when read
together, explain which drug tests can be billed with multiple units of G0431-QW and
which have to be billed as 1 unit of G0430-QW. These Transmittals were
accompanied by a MLN Matters No. 6800 which provides further instructions.
By way of background you may remember that the prior CPT Codes, 80101 (single
drug class) and 80100 (multiple drug classes) were left intact by the AMA, but
Medicare adopted replacements using G0431 (single drug class) and G0430
(multiple drug classes). There was mass confusion due to the wording of the new
codes, and CMS promised, and now has delivered, an explanation which is effective
this Thursday, April 1, 2010.
According to CMS, here are the coding instructions: (1) G0430-QW is to be billed
when multiple drug classes are tested when the testing methodology does not use
the chromatographic method; (2) 80100–QW is to be used when testing for multiple
drug classes that do use the chromatographic method; (3) G0431 is to be used per
drug class when performing a test for a single drug class; and (4) Medicare will no
longer recognize 80101.
That still doesn’t answer the single cup/multiple dipstick methodology and tell us
which G code is to be used with which test. To respond to that, CMS actually
provided a list of tests which fall under G0430, and which tests fall under G0431.