Re: G0434 - New drug screen code claim denial questions

[Guest guest]

Beth, call back and tell them you have read all the information you were

directed to and still cannot figure out what was done wrong. If the person you

speak to cannot help you, ask nicely to speak to their supervisor. If that

person can't help you, ask to speak to THEIR supervisor, etc. Sometimes, they

will admit they cannot find that you did anything wrong, and they will " put it

through for you. " Then, if it happens again, repeat the above but tell them you

want to know what to do differently so that it doesn't keep happening. If you

have a billing software company, you might also check that your CLIA number is

being put in the correct location on the CMS 1500. The key is, don't give up and

continue doing these things for free. It took me several months and many phone

calls to get my u/A's paid for by Medicare.---Sharlene

>

> I need some help figuring out what we did wrong. We did a drug screen on a

> Medicare patient who receives a prescription for pain meds to treat his

> cancer related pain. We do a drug screen too verify that no additional meds

> are being taken that aren't prescribed. We billed a G0434 QW for a CLIA

> waived drug screen for 6 drugs done in our office on 01/19/2011. We billed

> the G0434 with a unit of 1. The screen was denied with the following

> reason codes:

>

> . CO-4 - procedure code is inconsistent with the modifier used or a

> required modifier is missing.

>

> . MA130 - Your claim contains incomplete and/or invalid information

>

>

>

> The diagnoses used were 304.03 - pt has a past history of opioid dependence

> and has been treated in outpatient methadone treatment program for 5 years

> and V58.69. I have a level 4 - provider performed microscopy CLIA

> certificate which covers all CLA tests up to and including provider

> performed microscopic tests. The certificate number was transmitted on the

> claim.

>

>

>

> When I called Cahaba about this denial, they just directed me to the Med

> Learn Matters document on this new code which clearly states that the QW

> modifier should be applied to CLIA waived tests performed in a CLIA waived

> lab. Since this drug screen was done during a visit to monitor his chronic

> conditions including HTN, elevated lipids, BPH, and low vitamin D as well as

> receive a prescription for his chronic meds and his pain medicine for the

> acute pain associated with his malignancy we also billed a level 99214 E & M

> visit. For the same date of service. What am missing? How should I go

> about getting this problem corrected so these drug screens will be paid.

>

>

>

>

>

> Dr. Beth Sullivan, DO

>

[Guest guest]

And don't be surprised that you get a different answer! I've added modifiers and had the next person tell me take it away -- still not get paid! Then go back to putting it on and this time it goes through! Go Figure! Make sure you listed yourself as the ordering doctor as well as checking on that CLIA number actually being on the CMS 1500. Good Luck.

To: Sent: Sun, May 8, 2011 8:29:34 PMSubject: Re: G0434 - New drug screen code claim denial questions

Beth, call back and tell them you have read all the information you were directed to and still cannot figure out what was done wrong. If the person you speak to cannot help you, ask nicely to speak to their supervisor. If that person can't help you, ask to speak to THEIR supervisor, etc. Sometimes, they will admit they cannot find that you did anything wrong, and they will "put it through for you." Then, if it happens again, repeat the above but tell them you want to know what to do differently so that it doesn't keep happening. If you have a billing software company, you might also check that your CLIA number is being put in the correct location on the CMS 1500. The key is, don't give up and continue doing these things for free. It took me several months and many phone calls to get my u/A's paid for by Medicare.---Sharlene>> I need some help figuring out what we did wrong. We did a drug screen on a> Medicare patient who receives a prescription for pain meds to treat his> cancer related pain. We do a drug screen too verify that no additional meds> are being taken that aren't prescribed. We billed a G0434 QW for a CLIA> waived drug screen for 6 drugs done in our office on 01/19/2011. We billed> the G0434 with a unit of 1. The screen was denied with the following> reason codes: > > . CO-4 - procedure code is inconsistent with the modifier used or a> required modifier is missing.> > . MA130 - Your claim contains incomplete and/or invalid information> > > > The diagnoses used were 304.03 - pt has a past history of opioid

dependence> and has been treated in outpatient methadone treatment program for 5 years> and V58.69. I have a level 4 - provider performed microscopy CLIA> certificate which covers all CLA tests up to and including provider> performed microscopic tests. The certificate number was transmitted on the> claim.> > > > When I called Cahaba about this denial, they just directed me to the Med> Learn Matters document on this new code which clearly states that the QW> modifier should be applied to CLIA waived tests performed in a CLIA waived> lab. Since this drug screen was done during a visit to monitor his chronic> conditions including HTN, elevated lipids, BPH, and low vitamin D as well as> receive a prescription for his chronic meds and his pain medicine for the> acute pain associated with his malignancy we also billed a level 99214 E & M> visit.

For the same date of service. What am missing? How should I go> about getting this problem corrected so these drug screens will be paid. > > > > > > Dr. Beth Sullivan, DO>

[Guest guest]

I always put steve As the ordering, rendering, and referring provider for any in-house lab. Add QW modifier and put the CLIA # in there. As long as it's a covered Medicare benefit, you should get paid. If it's not a covered benefit, you need to have the patient sign an ABN. Also look at your local carrier's determination for the cpt code (also called an LCD). Some codes will only be paid with specific icd-9 codes. For example, if you do an EKG and have a sore throat icd-9, they won't pay, even if it is your 3rd or 4th code. Good luck!

And don't be surprised that you get a different answer! I've added modifiers and had the next person tell me take it away -- still not get paid! Then go back to putting it on and this time it goes through! Go Figure! Make sure you listed yourself as the ordering doctor as well as checking on that CLIA number actually being on the CMS 1500. Good Luck.

To: Sent: Sun, May 8, 2011 8:29:34 PMSubject: Re: G0434 - New drug screen code claim denial questions

Beth, call back and tell them you have read all the information you were directed to and still cannot figure out what was done wrong. If the person you speak to cannot help you, ask nicely to speak to their supervisor. If that person can't help you, ask to speak to THEIR supervisor, etc. Sometimes, they will admit they cannot find that you did anything wrong, and they will "put it through for you." Then, if it happens again, repeat the above but tell them you want to know what to do differently so that it doesn't keep happening. If you have a billing software company, you might also check that your CLIA number is being put in the correct location on the CMS 1500. The key is, don't give up and continue doing these things for free. It took me several months and many phone calls to get my u/A's paid for by Medicare.---Sharlene>> I need some help figuring out what we did wrong. We did a drug screen on a> Medicare patient who receives a prescription for pain meds to treat his> cancer related pain. We do a drug screen too verify that no additional meds> are being taken that aren't prescribed. We billed a G0434 QW for a CLIA> waived drug screen for 6 drugs done in our office on 01/19/2011. We billed> the G0434 with a unit of 1. The screen was denied with the following> reason codes: > > . CO-4 - procedure code is inconsistent with the modifier used or a> required modifier is missing.> > . MA130 - Your claim contains incomplete and/or invalid information> > > > The diagnoses used were 304.03 - pt has a past history of opioid

dependence> and has been treated in outpatient methadone treatment program for 5 years> and V58.69. I have a level 4 - provider performed microscopy CLIA> certificate which covers all CLA tests up to and including provider> performed microscopic tests. The certificate number was transmitted on the> claim.> > > > When I called Cahaba about this denial, they just directed me to the Med> Learn Matters document on this new code which clearly states that the QW> modifier should be applied to CLIA waived tests performed in a CLIA waived> lab. Since this drug screen was done during a visit to monitor his chronic> conditions including HTN, elevated lipids, BPH, and low vitamin D as well as> receive a prescription for his chronic meds and his pain medicine for the> acute pain associated with his malignancy we also billed a level 99214 E & M> visit.

For the same date of service. What am missing? How should I go> about getting this problem corrected so these drug screens will be paid. > > > > > > Dr. Beth Sullivan, DO>