Wiki Billing CPT 82542 multiple times for single specimen

[mdameer159@gmail.com]

Hi there, any help/assistance on the below question will be grateful:

While processing Lab & Pathology services, I find the provider billing CPT "82542" with multi-units for only 1 specimen(Urine). Whereas, multiple drugs/metabolites analysis was done. So the question is:

Can we bill multiple units for single specimen? As the code description says "Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, EACH SPECIMEN"

Thanks
MA

 

[CodingKing]

When they say per specimen they mean 1 unit if its just urine. They don't mean for each thing tested for from the one specimen

[FONT=&quot]AMA Guidelines:[/FONT]

(Do not report more than one unit of 82542 for each specimen)
​

 

[karamac]

Question...

Hi there, any help/assistance on the below question will be grateful:

While processing Lab & Pathology services, I find the provider billing CPT "82542" with multi-units for only 1 specimen(Urine). Whereas, multiple drugs/metabolites analysis was done. So the question is:

Can we bill multiple units for single specimen? As the code description says "Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, EACH SPECIMEN"

Thanks
MA

The answer is NO, and I agree with Coding King-- my question is -- Are you billing drugs or non-drug analytes and metabolites in urine using 82542? If it is a drug, and I mean any drug- we bill those either using the G-Codes, or the AMA Definitive Drug Testing Codes (unless we are performing therapeutic drug assays- no urine here). There are a small, and I mean really small hanful, of scenarios that I can imagine where 82542 would be used in this setting. Especially based on your statement of "multiple drugs/metabolites analysis was done".

There is ALOT of confusion out there as to what to do if the drug I am testing for is not listed specifically in the CPT Definitive Drug Class Table. There are a couple of basic rules of the road--

1. You code that drug to the parent drug class. Meaning if you want to test for Atomoxetine (Strattera) used in the treatment of ADHD, everyone thinks it is a stimulant- BUT IT IS NOT-- it is actually a selective norepinephine reuptake inhibitor (SNRI) so the recommendation would be to bill it under the Antidepressants; serotonergic class, or it could potentially be under the Antidepressant; NOS class- but it is not an Amphetamine.

2. Drugs that don't fit in any drug class- then you can always use the 80375-80377 for Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified. Probably best practice here, is to ask, is it medically necessary to test for this substance, and what does the documentation in the chart say to support the testing? We have seen a trend lately where providers are choosing to order definitive drug testing for beta blockers, diabetic medications, statins without having a clear documented rationale for that testing in the chart.


Hope that helps!