Pain Management Medical Coding Update: Updated HCPCS Codes for Drug Screens


We have some new HCPCS codes for drug screens, drug screens that many of our pain management providers do particularly if they are doing medication management.

The G code G0430, they thing here is it is not a mirror image of the 80100 code or the 80101 code. It's because it says other than chromatographic each procedure.

So if your docs are doing a single dipstick that has multiple drug classes on it or multiple individual drugs, this would be the code that we'd be reporting for Medicare. The key thing is that it's going to be maximum of one unit of service. It provides that medical coding and billing option for the new or multiple drug cuts.

And likewise, the G0431 is for a single drug class. This is a mirror image of the code description of 80101. These codes will be no longer reportable for Medicare.

We will still append the -QW modifier to these new codes when they're clearly waived. And so, that - my understanding is that we don't have any transmittals out.

AS per the updated medical coding and billing guidelines, We have some changes on our J-codes. For those of you that have providers that do Botulinum toxin injections, we've had two changes in our existing codes. Instead of saying Botulinum Toxin-A and Botulinum Toxin-B, were actually using the underlying descriptor for the particular traded drug on a Botulinum Toxin-A will continue to be used for Botulinum Toxin A Botox. And then J0857 is Rimabotulinum Toxin B. That's for the Botulinum Toxin-B drug, Myobloc.

And we in fact have a new HCPCS code for a new type of Botulinum Toxin-A drug that's for dysport. That's d-y-s-p-o-r-t. It was released FDA approved. It has been used extensively in Europe.

The key thing we want to point out is we want you to look very closely at those code descriptions if they are different units. So the Botox is one unit of service. One unit of billing service is one unit of drug. The dysport is one billing unit is five units of drug. And the Myobloc is one billing unit is a 100 units.

So you need to be very careful in calculating and getting this correctly reported if you're doing Botulinum toxins because these are fairly expensive drugs. And we want to make sure that we're accurately reporting our units of service.

We also have a new – for those of you that are having docs that are injecting what we call the WD40. The key thing here is that we have a joint code for the Synvisc and Synvisc-one. As per the new medical coding and billing guidelines, We have a deletion of the original Synvisc code. Synvisc-One is a newer type of Hyaluronate that is injected with only one dose rather than the multiple dose like Synvisc or the other Hyaluronate drugs.

The key medical coding update we want to point here that the other drugs in the past, Synvisc and the other drugs will continue to be as per dose. So if the syringe has come in three packs and you use one syringe today, you're going to report the code with one unit of service. When they come back again in two weeks later and they inject another syringe, you would report one unit of service. That is not the case for Synvisc and Synvisc now. It is per milligram.

So for example, if the dosage happens to be 16 milligrams, we're actually going to be reporting 16 units of billing unit.

According to the updated medical coding and billing guidelines, we have some new HCPCS modifier. These coincide with those E-codes where we've had surgery on the wrong body part, surgery on the wrong patient and then a wrong surgery on the crack patient. So again,  PA-PBPC.

What we need to point out is Medicare, some of the contractors have noticed that providers have been incorrectly reporting PC as the new professional component for radiologic codes. So instead of reusing 26, some providers have been using PC. And that is absolutely unequivocally incorrect.

First of all, it's going to deny it because they think that you're saying it's a wrong surgery on that patient. We should not be using PC to meet professional component. We're going to continue to use that modifier -26 for the professional component. PC, you're telling that Medicare contractor that you performed the wrong surgery on that patient.

We had a new modifier for the ABN notice. The new modifiers GX, it's just letting Medicare know is that we did get an ABN. But we got an ABN for something that didn't require. It's a voluntary use.

That GY modifier is not deleted. You can also report the GX and the GY together on that same line of item. We also had a minor revision of that GA modifier as that underlying part as required by payer policy. So just minors.

We had a change to the HCPCS codes, Implantable Neurostimulator Electrode that changes with any number of contact points. The code description implantable neurostimulator electrode each, originally when we first saw the changes in the HCPCS, we thought they were going to intend that this was per lead or per (ray). However they have released the tentative allowables for these medical coding and billing coding options and they're the exact same.

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