I would review the below from Palmetto, they are stating certain in-office instruments create a semi-quantitative and should not be billed using quantitative codes. Additionally, routine performance of quantitative testing would be subject post payment review and potentially in-depth audits.
Within the AMA CPT Manual they have a chart with the different drugs and their quantative code. I copy and pasted a list I found that has quan. testing codes but did not cross check if these are current. The Medicare LCD has specific guidelines for billing. Such as it would not be appropriate to do a quantative screen for a drug/drug class that tested negative with the initial qualitative screen. I think that is important point. And the fact is there an order for quantative screen and what documentation on positive screen will the quantative result yield as a better understanding of how to manage the patient.
http://www.palmettogba.com/palmetto...edicare~Articles~Drugs Biologicals~8Q2LHW8528
Railroad Medicare
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
Below is from WPS Medicare J5
A positive qualitative screen often results in an inadequate result upon which to make a proper determination. A more specific method, such as gas or liquid chromatography coupled with mass spectrometry, may be needed in order to obtain a confirmed analytical result. In particular, qualitative screens are frequently inadequate for interpretation of opiate and benzodiazepine results; quantitative testing may be needed in these instances. Confirmation testing is usually not required for drugs like methadone, wherein false positive results are rare. However, factors such as cross-reactivity with other similar compounds or interfering substances in the specimen. Confirmatory testing eliminates the risk of false positives. Also eliminated by confirmation is the risk of a ?pill scraper? slipping through. Patients diverting their drug attempt to cheat the test by scraping a bit of drug from a pill into their urine sample. It would screen positive, but there would be no metabolite upon confirmation. Frequent use of this code will be monitored for appropriateness.
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Alcohol Metabolites (EtG/EtS) Confirmation 82055
Amphetamines Confirmation 82145
Barbiturates Confirmation 82205
Benzodiazepine Confirmation 80154
Cannabinoids/THC Confirmation 82542
Carisoprodol/Meprobamate Confirmation 83805
Cocaine Metabolite Confirmation 82520
Fluoxetine Confirmation 80299
Gabapentin Confirmation 82491
Methadone Confirmation 83840
Methylphenidate Confirmation 82491
Opiates Confirmation 83925
Buprenorphine Confirmation 83925
Fentanyl Confirmation 83925
Propoxyphene Confirmation 83925
Tapentadol Confirmation 83925
Tramadol Confirmation 83925
Phencyclidine Confirmation 83992
Pregabalin Confirmation 82542
Sertraline Confirmation 80299
Tricyclic Antidepressants Confirmation
Amitriptyline Confirmation 80152
Cyclobenzaprine Confirmation 80299
Desipramine Confirmation 80160
Doxepin Confirmation 80166
Imipramine Confirmation 80174
Nortriptyline Confirmation 80182
Zaleplon Confirmation 80299
Zolpidem Confirmation 80299
Zopiclone/Eszopiclone Confirmation 80299
Imipramine Cutoffs
Drug Cutoff CPT Code
Imipramine 25 ng/ml 80174