FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
Contractor’s
Determination Number
G0431
LCD Database ID
Number
L30574
Contractor Name
First
Coast Service Options, Inc.
Contractor
Number
09102 –
09202 – Puerto Rico
09302 –
LCD Title
Qualitative Drug
Screening
Coding
Guidelines
Effective April 1, 2010, when
performing a qualitative drug screening test for multiple drug classes that use
chromatographic methods. CPT code 80100 is the appropriate code to
bill. HCPCS code G0430 was created to
limit the billing to one time per procedure and to remove the limitation of the
method (chromatographic). Therefore,
when a clinical laboratory that does not require a CLIA certificate of
waiver performs a qualitative drug screening test for multiple drug classes
that does not use chromatographic methods, HCPCS code G0430 is
the appropriate code to bill. When a
clinical laboratory that does require a CLIA certificate of waiver
performs a qualitative drug screening test for multiple drug classes that does
not use chromatographic methods, HCPCS code G0430QW is the appropriate code to
bill.
Effective April 1, 2010,
HCPCS code G0431 should be utilized by those clinical laboratories that do
not require a CLIA certificate of waiver.
Those clinical laboratories that do require a CLIA certificate of
waiver should utilize HCPCS code G0431QW.
Effective January 1, 2011,
HCPCS code G0430 was deleted and replaced with HCPCS code G0434 – Drug screen,
other than chromatographic; any number of drug classes, by CLIA waived test or
moderate complexity test, per patient encounter. In addition, CPT code 80100 is no longer a
valid code for Medicare purposes and HCPCS code G0431 should be billed when
applicable.
Effective for claims processed
on or after March 3, 2011, for dates of service on or after January 1, 2011,
HCPCS code G0431QW was deleted from the Clinical Laboratory Fee Schedule
(CLFS). HCPCS code G0431 describes a high complexity test, and should not be
reported with a QW modifier; the QW modifier indicates a Clinical Laboratory
Improvement Amendments (CLIA) waived test.
Also,
Effective for claims
processed on or after March 3, 2011, for dates of service on or after January
1, 2011, HCPCS code G0434QW was added to the CLFS. HCPCS code G0434 can describe a CLIA waived
test. The use of the QW modifier to
indicate a CLIA waived test is necessary for accurate claims processing. Both HCPCS codes G0431 and G0434 will remain
on the CLFS.
Use CPT code 80102
for drug confirmation.
For management of patients under treatment of
substance abuse or management of patients with chronic pain, point of service
qualitative urine drug screen is the most frequently utilized testing. This testing is described by G0434 and is
billed one unit per patient encounter.
Comments
N/A
Revision History
|
Date |
Revision |
|
03/03/2011 |
4- Under the “Coding
Guidelines” section, based on JSM 11194 and Change Request 7266 language was
added regarding the deletion of HCPCS code G0431QW from the CLFS, and addition of HCPCS code G0434QW to the CLFS. The
effective date of this revision is for claims processed on or after 03/03/2011
for dates of service on or after 01/01/2011. |
|
02/13/2011 |
3- Under the “Coding Guidelines” section,
language was added to clarify point of service qualitative urine drug screen
for number of units billed. Also, based on CR7300, effective 1/1/2011, CPT
code 80100 was noted as no longer being a valid code. The effective date of this Coding
Guidelines revision is based on date of service. |
|
01/01/2011 |
2 – January 2011 HCPCS information
regarding HCPCS code G0430 replaced with HCPCS code G0434 was added under the
“Coding Guidelines” section. The
effective date of this revision is based on date of service. |
|
04/01/2010 |
1 - Deleted previous instructions regarding
the billing of qualitative drug screening.
Added information related to procedure codes 80100, G0430 and G0431
and the use of modifier QW. The
effective date of this revision is based on date of service. |
|
01/25/2010 |
Original |
Document formatted: 03/02/2011
(DA/et)