Pathology/Lab Coding Alert

Question: Our lab performs a broad drug class screening test using liquid chromatography and mass spectrometry (LC/MS) with reflex to a definitive test for any positive findings. In a specific case, test results were positive for three drug classes, and the lab performed an additional LC/MS procedure, which quantified the levels of the specific drugs and their metabolites. Can we report a screening and definitive test together, and if so, do we need a modifier?

Georgia Subscriber

Answer: Yes, you may perform and bill for a presumptive and definitive drug test on the same date of service. In fact, clinicians often order a screening test for possible drugs of abuse, and then perform a definitive test if the screening is positive. You should not need a modifier to bill for both tests.

For Medicare, you would bill the testing you described using the following two codes:

• 80307 (Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service)
• G0480 (Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed)

For non-Medicare patients, the screening code stands (80307), but you should code the definitive assay(s) based on the drugs you’re testing for using codes in the range 80320 (Alcohols) to 80377 (Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 7 or more).

Remember: Each code in the range 80320-80377 represents a different drug class or drug and includes all drugs and metabolites in the listed class (except for rare cases that involve a specific metabolite code). The definitive tests are more specific than presumptive tests and can identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers). Clinicians may order definitive testing as the first test, or as a confirmatory test following a positive screening drug test.

Caution: Most payers won’t cover the definitive drug test codes without a medically necessary reason, such as a positive screening test, or symptoms that the clinician deems suspicious for drug overdose. Reporting a screening test for multiple drug classes as multiple definitive drug tests is fraudulent coding.