Wiki 80100 80101 80102 suboxone and drug tests

[hthompson]

I'm getting very confused with all the codes and meanings.

I have been using 80100 for our CLIA WAIVED One Step Multi-Drug Multi-Line Screen Test Device. Tests for amphetamine, cocaine, marijuana, methamphetamine, opiates, and phencyclidine. It is a chromatographic immunoassay for the qualitative detection of multiple drugs and drug metabolites in urine. I have to use a -ZS modifier for Medi-Cal.

I was comfortable thinking that I'd use the 80101 for suboxone screenings until I looked in the Medi-Cal manual to see if I needed a modifier. There is a section on pathology: drug testing that G0431, G0434, 80102 and 83925 are acceptable codes to bill to them.

Further in the manual it says Code 80102 is used to bill the testing for the presence (qualitative testing) of any drug, drug class or substance of abuse. This code is not restricted to any specific laboratory method or technology. Additional different testing is allowed, when necessary, to confirm a positive initial qualitative screening test.

Then further than that it says Outpatient heroin (narcotic) detoxification programs may not bill for CPT-4 code 80102 since payment for screening tests is included in the Medi-Cal-per-visit allowance for these programs.

Now my question is, is the correct code for the screening of Suboxone 80101 or 80102. I know that I keep seeing that 80102 is a confirmation of a previous positive result, but COULD it be interpreted to mean that 80102 is confirming the presence of a drug that should be there in the first place? I know, I'm probably reading into it.

Just trying to get the proper answer. Thanks!!

Any feedback would be great even if it's confusing

 

[hthompson]

bump! Please!

 

[brockorama01]

I have as many questions as answers for you:

The 80100 and 80101 are no longer valid to bill Medicare as of 4-1-10. For 2011, for a dip strip urine drug screen (any number of tests or any type of drugs..including suboxone) the code is G0434 for ONE unit. In my pat of the world (Indiana, Michigan and Illinois), if you the drug screen test is CLIA approved and your are CLIA waived then include the QW modifier.

Commercial carriers and some Medicaid's still use the 80101 and 80100 codes. It looks like yours uses the G codes. (Medi-Cal is California Medicaid right?)

The 80102 confirmation code is rarely used. It is a qualitative confirmation of a another qualitatve test. If there was a doubt with the initial qualitative result, most offices would just send the same to a confirmation reference lab for a quantitative result. Do you use a reference lab? Also, what other qualitative testing is there to confirm besides dip strip tests (unless you are "moderately complex"?

Also, you have a urine strip test that can test for suboxone?

As for detox programs not billing 80102 as bundled, that is probably true.

And finally, how are you screening Suboxone 80101? Is it the same urine dip test as the rest of the drugs? If so, it's bundled too.

 

[hthompson]

I have as many questions as answers for you:

The 80100 and 80101 are no longer valid to bill Medicare as of 4-1-10. For 2011, for a dip strip urine drug screen (any number of tests or any type of drugs..including suboxone) the code is G0434 for ONE unit. In my pat of the world (Indiana, Michigan and Illinois), if you the drug screen test is CLIA approved and your are CLIA waived then include the QW modifier.

I will make a note, I didn't notice if any of those patients were Medicare.

Commercial carriers and some Medicaid's still use the 80101 and 80100 codes. It looks like yours uses the G codes. (Medi-Cal is California Medicaid right?)

Yes, Medi-Cal is California Medicaid. But we aren't fee for service, so I haven't ever used G codes. I need to see if it's a requirement.

We also have managed care Medi-Cal, so maybe they DO take G codes? I'm not sure!

The 80102 confirmation code is rarely used. It is a qualitative confirmation of a another qualitatve test. If there was a doubt with the initial qualitative result, most offices would just send the same to a confirmation reference lab for a quantitative result. Do you use a reference lab? Also, what other qualitative testing is there to confirm besides dip strip tests (unless you are "moderately complex"?

The reason the "confirmation" 80102 was throwing me off is because usually you are testing for the presence of a drug and the patient "shouldn't be using" those drugs. The suboxone is different because you are confirming that the patient is actually following protocol and the patient "should" be using those drugs.

It is confusing, but I understand that it is confirming a previous positive result using a different method; I just wanted to make sure it couldn't be used in the aforementioned way.

Yes, we are using dip strips.

Also, you have a urine strip test that can test for suboxone?

Yes, there is a specific strip that tests for suboxone only.

As for detox programs not billing 80102 as bundled, that is probably true.

And finally, how are you screening Suboxone 80101? Is it the same urine dip test as the rest of the drugs? If so, it's bundled too.

We have a multiple drug strip that tests for illicit drugs and suboxone is its own strip.

Thanks for your feedback!

I think the proper way to bill is 80100 for the multiple drug strip and 80101 for suboxone. I will see what I can find re: Medicare and managed care Medi-Cal rules.