Wiki Drug Panels

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johnathan

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Hi Everyone, This is my first time to use the forum even though I have been a member for nearly 10 years.

Can anyone tell me the proper way to code for drug panels? We are doing an assay type dip test to do qualitative urine checks on patients that we are managing their pain management. We were sending these out. Now the lab is wanting us to do the qualitative and then send to them for the quantitative check.

We are a medium complex independent lab located within the clinic building. The reference lab is telling me to use 80101x11 (one for each drug class checked in the panel). They say this is the correct code because the immunoassay method is used. Whereas, 80100 is for multi drug classes and is to be charged only once per day, but the description states chromatographic method.

My quandry is to go by the multiple vs single description or the method. To use the 80101 feels like I would be unbundling and the "Coding Answer Book" states in it's most recent update 05/08, "It (80100) should be charged only once per day, for the urine or blood specimen analyzed, regardless of the method or the number of drug classes screened."

Which way should this be billed?::confused:
 
drug panel

You will do the qualitative for however many drugs you are testing. You will send them to the reference lab to do quantitative for those that are positive. Is this correct? Then they will be charging for the confirmation, each. I would use the 80101 x however many, you have 11. the description would be Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class.
 
How do you know that it would be correct to bill the 80101 x 11? As i said, in the Coding Answer Book update of May 2008, it states, "Procedure 80100 should be used to report a qualitative drug screen which is performed to detect the presence of multiple drug classes, regardless of the method or the number of drug classes screened."

I feel that I need documentation that the correct way to bill is different than the above statement if I break it down to 80101 x 11.

Now that we will be doing the qualitative screenings in our lab, we would be doing many of them. We would be reimbursed around $200.00 each time. I have nothing against profit, I just want to bill it the proper way and would love it if someone could give me another current reference stating we should bill it as 80101x11.[/QUOTE]
 
drug panels

johnathan said:
How do you know that it would be correct to bill the 80101 x 11? As i said, in the Coding Answer Book update of May 2008, it states, "Procedure 80100 should be used to report a qualitative drug screen which is performed to detect the presence of multiple drug classes, regardless of the method or the number of drug classes screened."

I feel that I need documentation that the correct way to bill is different than the above statement if I break it down to 80101 x 11.

Now that we will be doing the qualitative screenings in our lab, we would be doing many of them. We would be reimbursed around $200.00 each time. I have nothing against profit, I just want to bill it the proper way and would love it if someone could give me another current reference stating we should bill it as 80101x11.
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[/QUOTE]

It depends on what panel you are doing, there are different ones. Your facility will have a certain panel and it will consist of certain drug classes (opiates, cocaine, sedatives etc) you will bill 80101 x however many of these drug classes you do. If you do 6 classes, you will bill x 6. Sorry, there's no easier way to do this. Maybe I'm just not explaining very well, I have that problem sometimes. Anyone else?
 
Just recently, our practice began performing and billing for point of care drug screening. Prior to our involvment in the point of care testing, our providers would only identify a patient that needed to be tested and send them out for quantitative screening.

However, the company that performed the drug screening told us that we were missing an opportunity to bill out for the qualitative portion of the service. They told us that we could purchase a POCT (point of care test) cup with several panels on them and bill for the qualitative interpretation of each panel.

Since we already had our Clia waiver we purchased CLIA waived 6-panel cups and began our testing. We are billing out 80101-QW x 6. We are appending the QW modifier to all payors. To date it appears the insurance carriers are reimbursing the multiple panels, however their is still a question on should this service should be billed x6 or x1. I have posed the question to our attorney who is also a CPC for guidance. I will repost once I get clarificaton. I know of one other pain clinic in the surrounding area that is interested in performing this service with similiar questions. With reimbursement of $19 per panel this service could be very profitable, however as it almost always is with suggestions from vendors, its almost too good to be true.
 
Another question about 80101

In response to this the laboratory at my work preforms the drug screens and we do an 11 panel test in which we bill 80101x11. In regards to what you should bill 80101 or 80100 I would talk to your lab manager, I clarified with mine and she stated the 80101 is the correct code for the testing we do. I do however have a question about billing the 80101. We bill 80101x11 and send 2 panels to LabCorp which they bill 80101x2. We are getting denials from Medicare stating a procedure will not be paid to two providers on the same DOS. Has anyone every had this problem? If so please help! Our denials started in late October and we have not found a solution. Thankfully we don't have many of these patients but it would be nice to have a solution.
 
From what I understand, 80100 is when you are looking to see if the patient is using drugs in general, without specifying the class. 80101 would be looking for specific drugs. You would bill 80101 for each drug class you test for.
 
Researching 80101

In response to Jonathon, the NOvember 2006 CPT Assistant Coding Consultation issue from the AMA states " For code 80101, each single drug class method tested and reported is to be counted as one drug class. If a sample is anlyzed by five separate class-specific immunoassays and reported separately, code 80101 should be reported five times. Similarly, if a sample is run on a rapid assay kit composed of five class-specific immunoassays in a single kit, and the five classes are reported separately, code 80101 should again be reported five times. For example, an obtunded patient comes to the ED with a hx of possible drug abuse and the physician orders a drug screen for amphetamines, opiates, barbiturates, benzodiazepines, benzoylecgonine (cocaine), phencyclodine (PCP), and tetrahydocanabinol (marijuana). The laboratory performs single drug class screening for each analyte by means of immunoassay methods on a random acess analyzer. Code 80101 would be reported seven times, because this code is used to report immunoassay and enzyme assay, single drug class methods. Seven units are reported as each single drug class is reported separately. "

This reason I am sharing this with you now is because I myself am now researching this code for use by my physician, and this discussion thread came up when I searched.

Our office is not CLIA approved, but we have a state license for CLIA waived procedures. We are a PM & R practice and want to test for drug use at point of care.

Can anyone share what specific product, manufacturer, etc. they use if they are then billing 80101QW X # of drug class? We are shopping around for products right now.

Thank you.

Barbara
 
Also need drug panel answers...

I'm in the same boat with a lot of other coders not specifically understanding the drug testing codes. We are also a PM&R practice that just recently started doing the urine dip tests and the company that sold us our test kits is telling us to bill 80101-QW X 11 units. Does anyone have the answer is this is the correct coding for the urine dip with a single strip that has 11 sections to it that we are doing in our office?? I can understand the lab billing for 11 units on the confirmation testing but I can't find anything definate in writing to confirm our correct coding.
Thanks,
Nikki
 
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