ED Coding & Reimbursement Alert - 2015 Issue 9
Part B Coding Coach: Ignore Massive CPT® 2015 Drug Coding Changes for Medicare
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Article Overview
This piece covers the 2015 Medicare-specific transition for toxicology and drug testing claims, including how CMS handled the gap between new CPT® toxicology revisions and temporary HCPCS Level II reporting options. It is aimed at coders, billing staff, and laboratory professionals who need to distinguish Medicare reporting from non-Medicare reporting during the changeover period. The article also outlines the broad distinction between presumptive and definitive drug testing and points readers to the types of reference tables used to map older reporting to current payer-specific codes.
Why This Topic Matters
It matters because Medicare did not adopt the new CPT® toxicology reporting structure at the same time as other payers, creating a temporary split in coding workflows. Understanding the article helps labs and coding staff identify the correct general reporting pathway for Medicare versus non-Medicare claims during the 2015 transition.
Article Sections
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CMS problem and solution
Explains the Medicare reporting gap created by the 2015 toxicology update and the broad CMS response discussed in the article.
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Steps for 2015 Medicare reporting
Describes the practical workflow the article presents for handling Medicare claims during the transition period and the contrast with reporting for other payers.
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Toxicology selection tool
Introduces the table-based approach used to sort reporting options and distinguish among the major categories of drug testing discussed in the article.
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Presumptive is different
Covers the article’s discussion of the presumptive-versus-definitive distinction and how the 2015 coding update affects that broader category of testing.
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Except for Medicare
Summarizes the Medicare-specific alternative reporting approach described for qualitative screening services.
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Confirmation test
Addresses the article’s discussion of confirmatory testing and the unresolved Medicare reporting issue noted for that service category.
What You Will Learn
- How the article frames the 2015 Medicare transition for toxicology and drug testing.
- How the article distinguishes Medicare reporting from reporting to other payers.
- How the article organizes drug testing into presumptive, definitive, screening, and confirmation categories.
- How the article uses a table-based crosswalk to compare prior-year reporting with 2015 options.
- What general CMS and CPT® changes created confusion for laboratory coding workflows.
Who Should Read This
- Medical coders
- Laboratory billing staff
- Pathology and lab coding professionals
- Compliance and audit staff
- Laboratory managers
Codes Discussed
Code Ranges Discussed
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