Forum - Questions & Answers

Apr 20th, 2010 - sugarhigh05

G0431-QW Unbundling/Billing

Now that the G codes have been put into place, they've added the G0431-QW which is a little confusing. My question is this:

If you take the test strips and dip each separately, am I able to bill each strip separately or would this be considered "unbundling"? I want to be sure I do this correctly and there's a little bit of a gray area now that the QW has been added to the G0431 code.

Apr 21st, 2010 -

In their usual confusing way...

G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

seems to suggest that each drug class gets a "point" so if you have 5 classes then bill 5 units

Apr 21st, 2010 -

G0431QW Continued Question

Thank you for the response. I guess I have another question then:

Traditionally, before these changes occurred, we billed 11 drug classes for a multiple panel test cup. Now these cups are listed under G0430QW and only to be billed times one. So, if I buy single panel tests, and dip each drug individually, I can still bill out for each drug class? This seems to be circumventing Medicares original intent of limiting the billing to times one. I would think that would be considered the classic clinical laboratory test "unbundling", if there's a more appropriate code and methodology that pays much less. I guess I'm a little confused by the single panel reimbursement process and want to be sure it's done correctly, as I know the OIG is going to be paying extra attention to the reimbursement/billing process this year.

Apr 22nd, 2010 -

G0430qw

is a one-time code for a test that tests multiple drug classes at once. I interpret that to mean one strip has 5 or 10 or 11 little boxes that detect that many drugs. This is opposed to the previously discussed G0431 which is one drug class per test strip so you have to dip 11 different strips in the urine and can be billed out 5 or 10 or 11 times. It seems to boil down to supplies- G0430 if you use one test strip, G0431 billed x times if you use x number of unique strips.
(Of course I am just a doctor and could be totally wrong)



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