Wiki Primary DX for Urine Drug Screen-Pain Management

[kbus28]

I am billing for a Pain Management provider and we are having a debate on what the primary DX code would be for a urine drug screen (80307) done in the office at the same time as an f/u office visit. We have an insurance denying 80307 with primary DX of Z79.891- stating it is invalid DX (secondary DX codes are the conditions the PT is being treated for). In the past this particular insurance paid the 80307 but that was ONLY with the condition or pain DX codes.

I am now being asked to submit corrected claims with the condition/pain DX primary and Z79.891 secondary. The reason the urine test is being done is to verify what drugs the PT is or is no taking, therefore I feel Z code should be the primary DX. Below is an example portion of the note regarding the drug screen.



Any help or opinions would be appreciated because I am not sure if I am correct!! Thanks!!

 

[erjones147]

I work for a small outpatient clinic, and we have no problem billing a 80305-QW with Z79.891 as a secondary dx

I do think the reason for the pain meds should be primary over the "long-term use" code; the pain is the proximate reason for the encounter, not the actual taking of the pain meds (otherwise, the patient would just be a substance abuser) - YMMV

 

[Kristen Bensel]

I work for a small outpatient clinic, and we have no problem billing a 80305-QW with Z79.891 as a secondary dx

I do think the reason for the pain meds should be primary over the "long-term use" code; the pain is the proximate reason for the encounter, not the actual taking of the pain meds (otherwise, the patient would just be a substance abuser) - YMMV

I agree with you in regards to the order of the codes. You would want to sequence them as the reason for the medication primary, followed by the long term use code. But also remember the payer may have specific guidelines for the test on how they want the claim to look for coverage. There are some payers that would accept the Z79.891 as primary, and not cover it for the pain.