Toxicology Billing Changes Blue Cross Blue Shield of Georgia

With every new change implemented in the laboratory billing field, it seems Blue Cross Blue Shield (BCBS) finds new, inventive ways to hinder the claims process.

As you seek to increase your total revenue and streamline your billing cycle, you have to keep up to date with the best tips and tricks to navigate the nuances of laboratory billing and payer relations.

Let's dive into the next big change that BCBS is updating with their claims payment methods, and find out exactly how to get your drug testing claims processed and paid.

The Situation

The issue with toxicology billing being denied due to coding issues is coming up across a few BCBS states, mainly Georgia.

These toxicology billing changes implemented in 2018 have thrown a hitch in your revenue cycle when it comes to processing major CPT codes:

  • 80307- Drug test(s) that is presumptive for any number of drug classes by instrument chemistry analyzers like immunoassay, chromatography, and mass spectrometry (with or without chromatography) including a sample validation per date of service.
  • G0480-G0483- Drug test(s) that is definitive that can individualize and distinguish drugs including (but not limited to) GC/MS and LC/MS. This method is qualitative, quantitative, and excludes immunoassays and enzymatic methods. Shows 1-22 drug classes including metabolites if performed, and shows specimen validity testing per day.
  • G0659- Drug test(s) almost identical to G0480, but performed without method or drug-specific calibration, matrix-matched quality control material, or use of universally recognized internal standards for each drug.
Coding Changes for BCBS of GA (1)

These codes defined by the CMS, commonly used in testing urine or saliva for substance screening are typically billed in one claim form.

Ordering physicians request and require their conglomeration since they're both in regard to the same testing process.

However, as various BCBS factions across the US have instituted changes to the claims process that prevent processing these codes together, you need the knowledge to send these claims out efficiently without drastically slowing your productivity.

Our Recommendation

You have to perform your tests and code them the same way, but your processing can be optimized in order to avoid those "lovely" denied updates on your claims.

Here is the recommendation by CMS for payment:

Neither 80307 and G0480-G0483 will be payed together.

For these codes, there are two general recommendations:

  1. Crosswalk the confirmation to G0480-G0483 so you can get paid for 80307 and G0659 together (a crosswalk means you bill a test for the code of an existing, similar test in order to get it paid at the same rate)
  2. Or just run and bill for the G0480-G0483 confirmation only
What We Have Found That Works:

If you run the tests and bill them you won't get paid for them. BCBS isn't necessarily friendly like that.

If you don't run the tests you upset the ordering doctors and risk losing business.

Through our practices, we have found these two options to work based on the lab's specific circumstances:

  1. Run both 80307 and G0659 and bill for only 80307 for the screening and G0480-G0483 for confirmation instead of only billing for G0480-G0483. While you won't be getting reimbursed as much at least you're getting paid some.
  2. Run just confirmation G0480-G0483 since it is payable and you don't incur the cost of running the screen without reimbursement.

Take BCBS of GA for instance. As they contract at rates around 20-30% of Medicare it would pay around 30-35$ for each screening and definitive confirmation test.

In Summary 

As the largest payer in the US, Blue Cross Blue Shield is probably one that you deal mostly with for your lab, and as they update, so must you.

It might be wise to train your billing team to navigate around this roadblock in order to process your claims. Especially because it is a trend that is soon likely to pick up in the rest of the Blue Cross factions across the US. 

While your drug testing claims are getting denied for these coding discrepancies, your solution has to be adaptable.

Again, the correct method is circumstantial, but recommendations are leading the way in claim resolution.

Keep this in mind as you move forward with your payers to streamline your billing cycle and maximize your revenue.

Want the latest news, information, and tips in Laboratory Billing sent directly to your inbox? 

Subscribe to the Apache Health Blog

      FREE CONSULTATION

      Recent Posts

      Posts by Topic

      see all