Drug Test Coding...
would anyone be able to give me some insight or tell we where to find more information with coding 80307, G0481, G0482, G0483 drug testing. i am trying to find what the documentation requirements are, what a 14 class drug test would look like? any guidance would be appreciated.
80307- Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
G0480-Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift);; qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.
G0481- 8-14
G0482- 15-21
G0483- 22+
A 14 class drug screen on an instrument being billed with 80307 could look like the below list, but this is customizable by lab/physician and most do not have this many classes on a presumptive instrument.
Amphetamines
Barbiturates
Benzodiazepines
Oxycodone
Opiates
Methadone
Tricyclic Antidepressants
THC
Cocaine
PCP
EtG (ethyl glucoronide) one of the long acting metabolites of alcohol
Buprenorphine
Fentanyl (new reagent as of 2018)
Pregabalin
A 14 drug class definitive class test could include any of the above, along with some of these other classes:
Antidepressant; serotonergic
Antipsychotics
Skeletal muscle relaxants
Sedative Hypnotics.
One note, definitive testing of more than 1-7 classes is going to require some very detailed documentation of the medical necessity of each drug class. Definitive testing is primarily covered in three scenarios:
1. There is not a commercially available presumptive screen for that class, and that drug class is relevant in the patient's history (Rx or History of Abuse)
2. The presumptive screen was positive requiring definitive testing to provide individual drug data
3. The presumptive screen was unexpected negative for a prescribed medication of abuse.
Hope that helps...