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HCPCS codes changes for presumptive and definitive testing

There are new HCPCS codes introduced for presumptive and definitive testing. Every year there are new HCPCS codes added and old codes get deleted. Here, we have three new HCPCS codes for presumptive testing and four new HCPCS codes for definitive testing in 2016. Presumptive test is nothing but to detect the presence of drug in the urine sample. The results are reported quantitatively. Definitive tests are performed in the laboratory or by provider. The test is also preformed to find out the quantity of drug present in the urine sample. But, definitive tests are performed to confirm the presence of drug in the sample.

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New HCPCS codes for presumptive testing

There are three new G codes have been added for presumptive testing. Below is the detail description of these HCPCS codes.  

G0477 – Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service 

G0478 – Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service

G0479 – Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service

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New HCPCS codes for definitive drug testing

G0480 – Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed 

G0481 – Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed 

G0482 – Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed

G0483 
– Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed

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Points to remember while coding Presumptive and Definitive testing

Presumptive codes are reimbursed only when the testing is performed in an office, laboratory or facility setting.

Codes G0477-G0479 is limited to code only one unit per day. If coded more than one unit per day, it will be denied to be paid by the payer.

Only one of the three presumptive codes G0477, G0478 and G0479 should be coded per day.

Definitive testing codes G0480-G0483 are limited to reimburse only for one unit per day.

Only one definitive drug class codes in limited to code per day, which mean only one of the four definitive testing codes should be reported per day.

Modifiers 59, XE, XP, XS, XU and 91 should not be reported with procedure codes G0477-G0479 and G0480-G0483 to bypass the edits.

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List of deleted HCPCS codes from 2016

G6030                         

G6031                          

G6032                          

G6034                          

G6035                          

G6036                          

G6037                          

G6038                          

G6039                          

G6040                         

G6041                          

G6042                          

G6043                          

G6044                          

G6045                          

G6046                          

G6047                          

G6048                          

G6049                          

G6050                          

G6051                          

G6052                          

G6053                          

G6054                          

G6055                          

G6056                          

G6057                          

G6058