Can You Bill 80307 and G0480 Together?

Medical coding and billing in healthcare demand precision. Accurate coding is paramount for laboratories and providers to ensure proper reimbursement and compliance. This precision prevents claim denials, reduces audit risks, and supports the financial health of healthcare operations. Understanding the nuances of specific codes, especially for drug testing, is fundamental for effective billing practices.

Understanding Definitive Drug Testing Codes

Current Procedural Terminology (CPT) code 80307 represents presumptive drug class screening procedures. This code is used for qualitative testing across any number of drug classes, employing various devices or instrumented chemistry analyzers. Methods can include immunoassay, chromatography, or mass spectrometry, and it covers sample validation. Presumptive tests typically provide rapid results, indicating the presence or absence of a drug or drug class, but do not usually quantify specific levels.

Healthcare Common Procedure Coding System (HCPCS) code G0480 designates definitive drug testing. This code applies to methods capable of identifying individual drugs and distinguishing between structural isomers, utilizing techniques such as gas chromatography/mass spectrometry (GC/MS) or liquid chromatography/mass spectrometry (LC/MS). It excludes immunoassays and enzymatic methods. G0480 covers qualitative or quantitative results for one to seven drug classes, including metabolites, per day. Medicare often uses G-codes for drug testing, whereas commercial payers might use CPT codes.

Billing Considerations for Definitive Drug Testing

CPT code 80307 and HCPCS code G0480 cannot be billed together for the same service on the same date. These codes represent distinct types of drug testing: 80307 is for presumptive screening, while G0480 is for definitive confirmation. Billing both for the same patient on the same day implies an overlap in services that payers, especially Medicare, seek to prevent.

The National Correct Coding Initiative (NCCI) prevents improper payments for overlapping services. NCCI edits are automated prepayment edits designed to prevent duplicate billing when certain codes are submitted together. NCCI Procedure-to-Procedure (PTP) edits have existed between presumptive drug test codes (like 80307) and definitive drug test codes (like G0480). The principle of avoiding billing for both presumptive and definitive tests for the same purpose on the same day remains.

Payer policies often dictate appropriate code selection. Medicare typically requires G-codes (G0480-G0483) for definitive drug testing and does not recognize many CPT codes for reimbursement. Commercial payers may have their own guidelines, but many align with Medicare’s approach to prevent billing for both presumptive and definitive tests when one confirms the other. Some policies limit reimbursement to one definitive drug testing code per date of service, regardless of the number of drug classes tested.

Appropriate code selection depends on the type of test performed and the specific payer. If a rapid, qualitative screen is conducted to identify the possible presence of drugs, 80307 is the suitable code. If a highly specific, confirmatory test is performed using advanced analytical methods to identify and quantify specific substances, G0480 (or other appropriate G-codes based on the number of drug classes) should be used. Definitive testing is often medically necessary when presumptive results are inconsistent with clinical presentation, or when specific identification and quantification of drugs are needed for treatment decisions.

Supporting Documentation for Drug Testing Claims

Robust documentation in the patient’s medical record is essential to support any drug testing claim, whether billed under CPT 80307 or HCPCS G0480. This documentation must clearly establish the medical necessity for the test. It should include the patient’s history, physical examination findings, and previous laboratory results that justify the testing.

A written physician’s order specifying the medical necessity for the drug test, along with the particular drugs or drug classes to be tested, is required. The laboratory report must include the specific drugs identified, the methodologies used for analysis, and quantitative results if applicable. This documentation provides a clear audit trail and validates the services rendered, aligning with payer requirements.