Neurology & Pain Management Coding Alert

Question: Our pain management physicians perform random drug screenings, and I have a question about the correct way to bill 80101. Do we bill only one unit, or can we bill multiple units if they test for multiple drugs?

Kansas Subscriber

Answer: Report the codes based on the type of test or test kit your provider uses, and payer requirements.

• Submit 80104 (Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure) for the drug screen testing using a cup, cassette or dipstick that tests for multiple drugs/drug classes with one test kit, i.e. a cup that tests for 9 different drug classes. In this example, the provider would bill 80104 x 1 unit of service. Remember you report 80104 for the diagnostic lab test, not the test kit.
• By contrast, use 80101 (Drug screen, qualitative; single drug class method [e.g., immunoassay, enzyme assay], each drug class) to report drug screen testing that tests for a single drug class, such as an immunoassay analyser. If the provider uses this type of testing method, report 80101 with 1 unit of service for each separate drug class tested. If he performs separate testing for five different drug classes, for example, you'll bill 80101 x 5 units of service.
• Medicare and some commercial payers require G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter) for providers with high complexity CLIA certified labs that perform drug screen testing with a high complexity method. The maximum units of service would be 1.
• Medicare and some commercial payers require G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) for providers with either moderate complexity or CLIA-waived certified labs that perform drug screen tests. If the lab is moderate complexity certified and the test method is moderate complexity, the provider would report G0434 with 1 unit of service. If the lab is CLIA waived and the test method is likewise considered to be CLIA waived, report G0434-QW (CLIA waived test) with 1 unit of service. Append modifier QW when a CLIA waived lab is performing a CLIA waived test.