Drug Assay Coding - Your assistance please

smiedzian

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Hello all,

I have a new client who has been billing the following for Presumptive Drug Class Screening (urine). The Laboratory Requisition indicates Drug Screen and Full Confirmation for a Comprehensive Test Panel.

80307 - Drug tests, presumptive, any number of drug classes...by instrument chemistry analyzers, includes sample validation when performed per date of service
G0483 - Drug test(s) definitive, utilizing drug identification methods able to identify individual drugs ....including metabolite(s) if performed
82542 - Column chromatography, includes mass spectrometry if performed, non drug analyte(s) not elsewhere classified, qualitative or quantitative, each specimen.
82570 - Creatinine - other source
83986 - ph, Body fluid
83789 X2 - Mass spec and tandem mass spect...non-drug analyte(s), not elsewhere specified, qualitative or quantitative, each specimen
84311 X2 - Spectrophotometry, analyte, not elsewhere specified.

Research to date shows proper billing for what is documented on the report as 80307 and G0483. Codes 82570 and 83986 would appear to be included under the "sample validation" umbrella and not separately billable.
The questions I have are:

1. Is a specific order required to bill 83789, 84311 and 82542?
2. What additional documentation would need to be demonstrated to consider these codes billable? What they are telling me is that they use this when testing for non-drug analytes such as bath salts or glue, for example. However, on their current reporting form, none of these appear as detected or not detected, just the overall drug classifications.

All assistance is greatly appreciated.

Susan Miedzianowski, CPC
 

Cavalier40

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My question is why bill for the G0483 without results from the 80307? Is your definitive test more than 22 drug classes?

You are correct that 82570 and 83986 will deny inclusive to both the 80307 and G0483 as per their code descriptions.

As to the non drug analytes, I am not sure they can be separate from the G code. (somebody correct me if I am wrong). However in the world of confirmation testing, specifically testing for designer drugs is going to take a history of documented use or current suspicion of use, otherwise its not medically necessary to test for those substances.
 

karamac

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Drug Assay Coding- Your Assistance Please

Hi,

Cavalier40 is correct, in that the Creatinine (82570) and pH (83986) are not separately billable procedures and inclusive in both the presumptive and definitive testing codes of 80307 and G0483. Additionally, I would recommend caution and perhaps a very thorough review on whether those codes have been billed previously as per the OIG as well as NCCI edits these are not billable codes for some time. Creatinine and pH are valid codes, used in the treatment of patients who require these tests for other disease states, but are not appropriate when used in combination with presumptive and definitive drug testing. You should also review your private payer policies as a majority adopted the CMS position on specimen validity as early as 2013. Most clinical laboratories stopped billing for specimen validity testing in 2011-2012.

https://oig.hhs.gov/oas/reports/region9/91602034.asp

82542 is column chromatography for NON-DRUG per the CPT definition. I would be curious in this setting as to what they are using this code for, along with the two units of the mass spec codes. I have seen Spectrophotometry, used for Oxidants (incorrectly, I add) which again is part of specimen validity, and not a billable service in presumptive and definitive drug assays.

Most of the payers have established edits to hold 84311, 82542, and 83789 as they are not appropriate in this setting and not payable. What is the lab director stating that these codes are being used for?

Emerging drugs of abuse such as synthetic cannabinoids, synthetic cathinones ("bath salts"), fentanyl analogs, as well as your psychedelics all have AMA aligned drug classes that they fall into and are not separately billable under a separate code. In instances where there are drugs that you were not sure of it's alignment then you would assign 80375-80377 dependent on the number of drugs (remember drug metabolites are not counted separately). My go to when working with my clinical laboratory clients in determining where a drug falls is to use the Baselt textbook called Disposition of Toxic Drugs and Chemicals in Man, and the package insert if it is a marketed pharmaceutical. When you say that are testing for glue-- you mean the chemical components such as toulene, chloroform, propane, acetone and many halogenated hydrocarbons? Acetone, would be billed as 80320 and account for 1 drug class, and the others toulene, chloroform, propane and others would be billed with AMA codes 80375-80377 as mentioned above dependent on the number tested per specimen.

From my experience, your larger concern is the defense of G0483. There is very little clinical evidence that supports the testing of 22 or more drugs on any patient. The exception being in rare cases a patient who is unresponsive, and potentially in a coma. Multiple payers including Cigna, United, Humana all of have edits in place and this code along with G0482 will be denied with the request for medical records to support the medical necessity. Additional, there is very little clinical support that can back up the testing of volatiles (glue components) as you have mentioned above. Here is an article that will help, but this testing should be very, very focused on only those patients with a documented inhalant abuse and misuse profile. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766772/


The biggest mistake any lab can make is not reviewing there test menu to ensure alignment with the AMA designated definitive drug classes. I have multiple laboratories who have been audited because they did not group the drugs on the menu appropriately. A great example is Atomoxetine (Straterra) while it is used in the treatment of ADHD it is not a stimulant, rather it is norepinephrine reuptake inhibitor developed as an antidepressant. It falls into the Antidepressants, not otherwise specified (80338), but I have clients who have chosen to code it under Antidepressants; Serotonergic class (80332-80334) after discussions with their medical director.

Sorry if I sound like a complete lab geek, but I am ;) It's what I do every day all day...


Kara McVey, CPC, CPMA, CPCO
Owner - Ilex Consulting, LLC
kara@ilexconsultingllc.com
602-373-3894
 

CULINTZ

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Concerning CPT codes 80375 - 80377, Definitive drug testing NOS, how would the coder know how many analytes were tested if it isn't indicated on the order and the results only indicate positive results?
 

karamac

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80375-80377 are traditionally used for drugs that would not be categorized under any other drug class that the AMA has defined. Per CPT Assistant these codes are to be used for drugs that have not yet been classified by the FDA, so what does that mean for you...

1. The laboratory manager and/or director needs to provide you the coder the drugs that fall under that AMA description, one of the larger problems we have in drugs of abuse testing is that the testing menu's and laboratory information system designs have not been done based upon the AMA drug classes but forensic drug testing classes. Clinical AMA defined drug classification and forensic drug class classification are different.

2. The typical drugs that I have seen coded under these CPT codes are: hydroxizine, metroprolol, diphenhydramine, modafinil, guanfacine.... there is one thing that all of these drugs have in common -- a very difficult road to establishing the medical necessity of the drug - as they are not common drugs of abuse, and this type of testing (definitive drug testing) is not done to manage therapeutic levels of a drug as that is billed under the therapeutic drug monitoring codes.

3. Another issue, your result report should not reflect only the positive results, negative results are, if not more important to the clinical management of these patients. What if the patient is prescribed oxycodone, and oxycodone is positive but oxymorphone (the primary urinary metabolite) is negative? Depending on the level of oxycodone found, that patient could be pill scaping the oxycodone directly into the specimen, or taking the medication right before coming in the office. The metabolite of a medication is the indicator that we are primarily testing for in drugs of abuse testing via urine. This is also going to cause you issues under audit, as the auditor is going to have the same issues that you are having.

My last bit of advice, talk to the laboratory director and owner, these codes are essentially the "unlisted" codes of drug testing, and like all other unlisted codes garner more scrutiny. Palmetto GBA has a new draft LCD that I would expect to be adopted across contractors that is going to limit the coverage of multiple drug classes.

Hope that this helps, if you want take a screen shot of the drugs (just the drugs, no PHI) that reported out and I can tell you what I would code as the unlisted codes you mention. That might also help others on the thread.


Best,

Kara
 
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