Wiki Coding for a drug test

[AMDLnghrns]

We have a CLIA waived drug testing machine and have been running drug tests for some time now. We recently added in a few new reagents and are having some issues getting them paid for. Recommendations on the proper codes to use for THC and Ecstasy? We used 84999 since it is a chemisty drug, but some of our insurance companies continue to deny it. We were using 80299 and it was getting paid, but our office had issues with that as it is a therapeutic code, not a chemistry code.

Also, I am curious if it is allowed to bill for the quantitative test as well as the qualitative test.

Can anyone offer some assistance and evidence for both?

 

[dwaldman]

I would review the below, quantitative code result might not be what the instrument that is in the office is yielding and the quantitative codes might be the wrong selection. Although it may provide a numerical value, it might not be considered a quantitative result because the instrument is not providing a confirmation testing method such as gas chromography/mass spectrometry.

In regards, to a qualitative test followed by quantitative test, I would review the local coverage determination policy for the Medicare carrier you are billing.

Some carriers would state for a negative qualitative result, they would not expect to see this drug class then be tested and billed by a quantitative method.

I would work with the vendor who you purchased the testing instrument to find out if the result is semi-quantitative versus quantitative.



Jurisdiction 11 Part B
Semi-Quantitative Drug Testing: Billing/Coding Alert



Pain Management Billers:
If you are a point-of-care provider that bills services to monitor drugs of abuse and submits a quantitative code, you may be at risk for an overpayment request.

In order to effectively treat chronic pain, physicians rely on drug testing to monitor prescribed medications and drugs of abuse. Practices may purchase or lease enzyme immunoassay (EIA) devices to provide preliminary qualitative or semi-quantitative test results for monitoring purposes. EIA devices and the reagents used to perform in-office drug testing are FDA cleared only to obtain qualitative or semi-quantitative initial screen/preliminary results.

Since an immunoassay and an enzyme assay are by definition moderate complexity tests that produce qualitative and semi-quantitative results, they may not be reported with a quantitative code. Confirmation or quantification of the preliminary result is not usually produced in a point-of-care setting.

The initial drug screen/preliminary result should be reported with HCPCS code G0434, (Drug screen other than chromatographic; any number of drug classes), by CLIA waived test or moderate complexity test, per patient encounter.

The following codes should not be reported for the initial screen/preliminary result when performed by EIA:
?HCPCS code G0431 ? Drug screen, qualitative; multiple drug classes by high complexity test method
?CPT Chemistry section, codes 82000-84999
?CPT Drug Testing section, codes 80100-80104
?CPT Therapeutic Drug Assays section, codes 80150-80299

Use of the above codes to report preliminary qualitative or semi-quantitative test results is considered systematic up-coding and may lead to criminal and civil penalties.

If you believe your practice has made this error, it may be in your best interest to take the following actions:
?Complete a self-audit ◦Identify incorrect submissions
◦Contain further claim submission errors

?Consider self-disclosure protocol ◦Self-disclosure guidelines available on the OIG website

 

[dwaldman]

Here from the LCD for Medicare carrier in Texas, in regards to qualt. followed by quantitative testing.

"When a confirmatory test or a quantitative test is performed, the record must show that an inconsistent positive finding was noted on the qualitative testing or that there was no available, commercially or otherwise, qualitative test to evaluate the presence of a semi-synthetic or synthetic opioid in a patient who met the coverage criteria of this policy."

Local Coverage Determination (LCD):
Qualitative Drug Testing (L34352)

Contractor Name
Novitas Solutions, Inc. opens in new window Contract Number
04412 Contract Type
MAC - Part B

http://www.cms.gov/medicare-coverag...t+B)&s=51&DocType=Active&bc=AggAAAIAAAAAAA==&


Below is example of the type of testing that is falling under a quantitative code/Notice they mention liquid chromatography-Tandem Mass Spectrometry which would be seen in a lab setting. They are listing CPT 82542 for THC quantitative testing.


http://ltd.aruplab.com/tests/pub/0090369


Drugs covered: 9-carboxy-THC

Methodology: Liquid Chromatography-Tandem Mass Spectrometry

Positive cutoff: 5 ng/mL

The drug analyte detected in this assay, 9-carboxy THC, is a metabolite of delta-9-tetrahydrocannabinol (THC). Detection of 9-carboxy THC suggests use of, or exposure to, a product containing THC. This test cannot distinguish between prescribed or non-prescribed forms of THC, nor can it distinguish between active or passive use. The 9-carboxy THC metabolite can be detected in urine for several weeks. Normalization of results to creatinine concentration can help document elimination or suggest recent use, when specimens are collected at least one week apart.

__________________________________________________
For MDMA/Esctacy, it appears it falls under the amphetamine drug class and they are indicating they are using: 82145

http://ltd.aruplab.com/Tests/Pub/0090439


Drugs covered: methamphetamine, amphetamine, methylenedioxymethamphetamine (MDMA - Ecstasy), methylenedioxyethylamphetamine (MDEA - Eve), and methylenedioxyamphetamine (MDA).

Positive cutoff: 200 ng/mL

The absence of expected drug(s) and/or drug metabolite(s) may indicate non-compliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted/adulterated urine, or limitations of testing. The concentration value must be greater than or equal to the cutoff to be reported as positive. Interpretive questions should be directed to the laboratory

 

[marvelh]

A "CLIA waived drug test machine" can not produce a true quantitative result. If in fact the testing method is CLIA waived, you will likely only be using the G0434-QW or the 80104 codes.

If in fact, you are using a higher complexity analyzer, the results are still not considered to be quantitative, and the codes would likely be either G0431 for high complexity or G0434 for moderate complexity or 80101.