urine drug screen in pain management confused


Nashville, TN
Best answers
I am new to pain management/anesthesia coding and am confused about the coding of urine drug tests done in our office on patient's prior to being prescribed pain meds. The lab tech does a urine "dip" qualitative drug screening test that tests for 12 different classes of drugs. Our office is billing 80101x12 units for all insurances except for Medicare, which is billed as G0434-QW x1 unit. The charge differences in these is huge. The urine sample is also being sent to an outside lab (Ameritox) to "confirm" test results and they are apparently billing the patient's insurance for the test also.. this sooo does not sound right to me.. does anyone have any input? Thanks!
I know what you mean, I find myself reviewing informantion over and over, you would code what your office calls for,and the lab will code their servics, and then
your office will code (if any conformaition ( X's how many found) of any drugs found in those pre drug screens. Jen
The non-Medicare payer should being billed 80104 with quantity one if one is billing a urine drug screen utilzing a drug test kit that is simulaneously testing multiple drugs or drug classes in a single procedure. Medicare recognizes G0434-QW for CLIA waived drug test kit that commonly used for point of care testing.

The company or reference lab that is receiving the specimen can do a qualtative test and potentially bill 80101 per drug class or G0431 depending on the instrument, test method, and complexity of the test because they are personally performed that level of testing. This does exclude the billing for initial point of care testing performed in an office setting.

Below is from AMA CPT Assistant, where it is described of an instrument that utilizes immunoassay or enzyme immunoassay that individually tests the specimen per drug class using a more complex test method. The cost of this type of test is higher and the resources required are represnted by 80101 per classes that were ordered to be tested. Whereas, a drug test kit the resources are lower in cost (ie cost of the drug test kit) and 80104 and G0434 more accurately cover these type of resources used.

CPT Assistant
Drug Testing

Qualitative assays (ie, tests that detect whether a particular analyte, constituent, or condition is present or absent) are reported with the drug testing codes. Qualitative screen analysis using a multiplexed screening kit for multiple drugs or drug classes is reported with the new CPT code 80104. This new code was established to allay confusion when reporting qualitative analysis using a multiplexed method for 2-15 drugs or drug classes (eg, multidrug screening kit). Traditionally, a chromatographic method may have been used that identified multiple drug classes during a single procedure. This was represented by code 80100, Drug screen, qualitative; multiple drug classes chromatographic method, each procedure. Methods then became available that relied upon immunoassay or enzyme assay in which an assay identified the presence or absence of drugs within a single class. Each test run was for just one class and code 80101 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class described this method. More recently point of care and other testing can be used to identify multiple drug classes in a single test procedure. However, these assays do not utilize a chromatographic method, making code 80100 in appropriate to use. They may rely on immunoassays, for example. Kits are commercially available for 12 or more analytes. These test kits are often called "multiplexed" because of the ability to qualitatively assay multiple drugs simultaneously. It is effectively running multiple tests at once, in a single procedure, due to the test kit design. Prior to 2011, the reporting of qualitative testing for multiple drugs classes in a single kit was commonly reported as multiple units of code 80101 as code 80101 was not specific to a single or multiple sequential procedures. In 2010 a HCPCS code G0430 was created to describe a non chromatographic method wherein multiple drug classes were screened in a single procedure. New code 80104 represents this same procedure, more accurately reflecting the resources used in a multiplex test kit as compared to multiple runs using a single class methodology.



Effective January 1, 2011, CMS will utilize two test codes to report drug screen testing:

G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) will be used to report very simple testing methods, such as dipsticks, cups, cassettes, and cards, that are interpreted visually, with the assistance of a scanner, or are read utilizing a moderately complex reader device outside the instrumented laboratory setting (i.e., non-instrumented devices). This code is also used to report any other type of drug screen testing using test(s) that are classified as Clinical Laboratory Improvement Amendments (CLIA) moderate complexity test(s), keeping the following points in mind:
G0434 includes qualitative drug screen tests that are waived under CLIA as well as dipsticks, cups, cards, cassettes, etc, that are not CLIA waived

G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter) will be used to report more complex testing methods, such as multi-channel chemistry analyzers, where a more complex instrumented device is required to perform some or all of the screening tests for the patient. Note that the descriptor has been revised for CY 2011. This code may only be reported if the drug screen test(s) is classified as CLIA high complexity test(s) with the following restrictions:
G0431 may only be reported when tests are performed using instrumented systems (i.e., durable systems capable of withstanding repeated use).
I totally agree with dwaldman. If you are using a cup you should bill 80104 QW for non-Medicare and G0434 QW for Medicare.
If you have a screening cup that also does adulteration testing (Creatinine (CR), Glutaraldehyde (GL), Nitrate (NI), Oxidants (OX), ph (PH), Specific Gravity (SG). Can you bill for these seperately as well?
adulteration testing (Creatinine (CR), Glutaraldehyde (GL), Nitrate (NI), Oxidants (OX), ph (PH), Specific Gravity (SG).


I believe that the above would be inclusive to 80104 due to the fact attempting to reporting individual CPTs for the above would result in additional reimbursement for no additional resources incured to perform the adulteration testing.
Drug coding

I know what you mean, I find myself reviewing informantion over and over, you would code what your office calls for,and the lab will code their servics, and then
your office will code (if any conformaition ( X's how many found) of any drugs found in those pre drug screens. Jen

would you code one unit of 80102 for confirmation performed on a POC drug screen if you only billed one unit of 80104
Has anyone come across any insurance companies not wanting to pay on 80104 or G0434? We are running into an issue with Florida Medicaid not having these codes on their fee schedule, therefore the codes are not payable. We are a pain management office that sees many Medicaid patients and state law requires we perform urine drug screens on our patients but seeing as how FL Medicaid has yet to update their fee schedules to reflect these codes puts us in a bit of a pickle so to speak. Anyone familiar with FL Medicaid or have any insight on how to petition the state to reassess their fee schedules to reflect the updated codes?Thanks!

Here is where they describe confirmation testing that typically would be performed in a lab setting with 80102.

Clinical Example (80102)

A 20-year-old woman with a history of illegal drug use comes to the ED in a coma. The treating physician orders a drug screen necessarily without identifying any specific drug class to be tested. The laboratory performs a multiple drug class screen and reports back positive, consistent with opiates. The treating physician orders a confirmatory test, which the laboratory runs to confirm opiates using high performance liquid chromatography (not quantitative).