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HELP with Urine Drug Screening!!!!!!!!

  1. #1
    Default HELP with Urine Drug Screening!!!!!!!!
    Medical Coding Books
    The pain management clinic that I work for is starting its own high complexity urine lab in the office and we want to make sure we are billing correctly when the lab becomes CLIA Certified and starts running samples. The samples will be screened by way of a chemical analyzer using immunoassay, and based off the results the confirmation will be performed on LCMS. Confirmation for Rx that do not have an immunoassay will also be directly confirmed on the LCMS.

    We are pretty sure that the correct code to use for the immunoassay is 80101 x # of drug classes that are tested for, or G0431 for Medicare. (We will also check for sample adulteration by way of Creatinine, pH, Oxidants, and specific gravity on the chemical analyzer at the same time. Is there a specific code to use for this testing?) For the LCMS, the code we will use is 80102 x the number of confirmations performed. Can anyone comment on this?

    There has also been a lot of discussion about the diagnosis codes that should be used. We are comfortable using V58.69 for the established patients that are on a Rx treatment plan. The question comes into play for when its a new patient and the urine testing would be a baseline/initial drug screen, or the patient is not on a Rx plan but receives injections and follow-up visits every three months. We thought about using general diagnosis code like 724.2 low back pain, 723.1 neck pain, 724.1 thoracic pain, 729.5 limb pain, but then realized that these codes do not necessarily warrant a urine drug screen. Can anyone comment on the codes they are using and that are not being denied by insurance? Thank you in advance for your help. It is greatly appreciated!

  2. #2
    Default
    You would want to also review the up and coming drug testing codes for 2015. I have copy and pasted these below. Purchasing AMA CPT Changes 2015 could assist with this. For example, in contrast to reporting 80101 per drug class, CPT 80301 will be reported with 1 unit. And additional classes that are ordered from drug class list B under 80302 will be reported per procedure. You need to review the Local Coverage Determination policy for the Medicare carrier to see ICD-9 codes that meet medical necessity. For example, V58.69 is the only relevant code that is supports monitoring chronic pain patients with long term or current use of opioids. Below this is specifically described in the WPS Medicare J5 LCD. ICD-9 codes for the location of pain itself does not correlate the reason for the testing and I think you will find when you review your LCD, would not be covered.

    - determine the presence of other substances prior to initiating pharmacologic treatment
    - detect the presence of illicit drugs
    - monitor adherence to the plan of care


    You mentioned adulteration testing (Oxidants, PH, Urine Creatinine)
    CPTs such as 81005, 83986, 82570 are known to be reported for adulteration testing. But certain LCDs for Medicare contractors might have specific instructions preventing additional payment for this type of testing and find in inclusive into the payment for the primary testing.


    Below is from laboratory PDF describing the high complexity testing requirements that is granted to be able to report HCPCS G0431. There is an additional information regarding point of care testing using G0431 in this setting versus a laboratory setting.

    5) What is a High Complexity test according to CMS?

    According to CMS code G0431 now applies to a high complexity test only. This test is specific to its FDA approved complexity in its 510(k) application. A high complexity lab must perform this test. The personnel required in this lab must meet the specified CLIA Clinical Laboratory Personnel Requirements.

    http://www.alfascientific.com/wp-con...-Jan.-2011.pdf



    http://www.palmettogba.com/palmetto/...als~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.

    __________________________________________________ __________
    Below is from AMA CPT Assistant from 2000 for CPT 80102 regarding number of units which is pretty technical if not familiar with the testing methods described or how the current instrument that will be used corresponds to these guidelines. But it is important to note that CPT 80102 will be deleted in 2015. And the definitive codes will replace the confirmation testing. Other codes that such as 82541 will be revised to prevent the reporting for LC/MS using this type of code.

    Use 80102 for each procedure necessary for confirmation. As with the screening code (80100), for chromatography, each combination of stationary and mobile phase is to be counted as one procedure. For example, if confirmation of three drugs by chromatography requires one stationary phase with three mobile phases, report 80102 three times. However, if multiple drugs can be confirmed using a single analysis (eg, one stationary phase with one mobile phase), report 80102 only once.
    __________________________________________________ _____________
    WPS Medicare LCD J5 for UDS
    Medicare will consider performance of a qualitative drug test reasonable and necessary when a patient presents with one or more of the following conditions:

    1. For monitoring patient compliance during active treatment for substance abuse or
    dependence.
    2. A qualitative drug screen is considered medically reasonable and necessary in patients on
    chronic opioid therapy:

    - In whom illicit drug use, non-compliance or a significant pre-test probability of non-adherence to the prescribed drug regimen is suspected and documented in the medical record; and/or
    - In those who are at high risk for medication abuse due to psychiatric issues, who have engaged in aberrant drug-related behaviors, or who have a history of substance abuse.

    3. Medicare will consider performance of a qualitative drug test reasonable and necessary in patients with chronic pain to:

    - determine the presence of other substances prior to initiating pharmacologic treatment
    - detect the presence of illicit drugs
    - monitor adherence to the plan of care

    Drugs, or drug classes for which testing is performed, should reflect only those likely to be present, based on the patient's medical history, current clinical presentation, and illicit drugs that are in common use. Drugs for which specimens are being tested must be indicated by the referring provider in a written order.

    A qualitative drug test may be reasonable and necessary for patients with known substance abuse or dependence, only when the clinical presentation has changed unexpectedly and one of the above indications is met.

    A qualitative drug test may be reasonable and necessary for patients with symptoms of schizophrenia suspected to be secondary to drug or substance intoxication.

    Confirmation of drug testing (80102) is indicated when:

    1. The results of the qualitative screen are presumptively positive.
    2. Results of the qualitative screen are negative and this negative finding is inconsistent with the patient's medical history.
    3. This test may also be used, when the coverage criteria of the policy are met AND there is no qualitative test available, locally and/or commercially, as may be the case for certain synthetic or semi-synthetic opioids.

    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 and therefore; 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 may effect test results. 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.

    __________________________________________________ ______
    2015
    Presumptive Drug Class Procedures

    80300 Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service

    80301 Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service

    80302 Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure80303 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (eg, acid, neutral, alkaloid plate), per date of service

    80304 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure

    Drug Class A

    Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants

    Drug Class B

    Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified

    Definitive Drug Class Procedures

    80320 Alcohols
    80321 Alcohol biomarkers; 1 or 2
    80322 Alcohol biomarkers; 3 or more
    80323 Alkaloids, not otherwise specified
    80324 Amphetamines; 1 or 2
    80325 Amphetamines; 3 or 4
    80326 Amphetamines; 5 or more
    80327 Anabolic steroids; 1 or 2
    80328 Anabolic steroids; 3 or more
    80329 Analgesics, non-opioid; 1 or 2
    80330 Analgesics, non-opioid; 3-5
    80331 Analgesics, non-opioid; 6 or more 1 or 2
    80332 Antidepressants, serotonergic class;1 or 2
    80333 Antidepressants, serotonergic class; 3-5
    80334 Antidepressants, serotonergic class; 6 or more
    80335 Antidepressants, tricyclic and other cyclicals; 1 or 2
    80336 Antidepressants, tricyclic and other cyclicals; 3-5
    80337 Antidepressants, tricyclic and other cyclicals; 6 or more
    80338 Antidepressants, not otherwise specified
    80339 Antiepileptics, not otherwise specified; 1-3
    80340 Antiepileptics, not otherwise specified; 4-6
    80341 Antiepileptics, not otherwise specified; 7 or more
    80342 Antipsychotics, not otherwise specified; 1-3
    80343 Antipsychotics, not otherwise specified; 4-6
    80344 Antipsychotics, not otherwise specified; 7 or more
    80345 Barbiturates
    80346 Benzodiazepines; 1-12
    80347 Benzodiazepines; 13 or more
    80348 Buprenorphine
    80349 Cannabinoids, natural
    80350 Cannabinoids, synthetic; 1-3
    80351 Cannabinoids, synthetic; 4-6
    80352 Cannabinoids, synthetic; 7 or more
    80353 Cocaine
    80354 Fentanyl
    80355 Gabapentin, non-blood
    80356 Heroin metabolite
    80357 Ketamine and norketamine
    80358 Methadone
    80359 Methylenedioxyamphetamines (MDA, MDEA, MDMA)
    80360 Methylphenidate
    80361 Opiates, 1 or more
    80362 Opioids and opiate analogs; 1 or 2
    80363 Opioids and Opiate analogs; 3 or 4
    80364 Opioids and Opiate analogs; 5 or more
    80365 Oxycodone
    80366 Pregabalin
    80367 Propoxyphene
    80368 Sedative hypnotics (non-benzodiazepines)
    80369 Skeletal muscle relaxants; 1 or 2
    80370 Skeletal muscle relaxants; 3 or more
    80371 Stimulants, synthetic
    80372 Tapentadol
    80373 Tramadol
    80374 Stereoisomer (enantiomer) analysis, single drug class
    80375 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3
    80376 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 4-6
    80377 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 7 or more

  3. #3
    Location
    Burlington, Vermont
    Posts
    48
    Default Clarifying question
    I'm relatively new to billing labs....Can G0431 be billed on the same day as 82570 or 83986?

  4. #4
    Default
    E. Drug Testing Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed. The Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 16 (Laboratory Services), Section 10 (Background) indicates that a laboratory test is a covered benefit only if the test result is utilized for management of the beneficiary?s specific medical problem. Testing to confirm that a urine specimen is unadulterated is an internal control process that is not separately reportable.

    http://www.cms.gov/Medicare/Coding/N...tEd/index.html

    Above is from the CMS NCCI Policy Manual.

  5. Default
    I have a question. If the lab is testing for 24 drugs, should 24 definitive drug classes be used to bill instead of 80301, for a higher reimbursement rate?
    I am billing with 80301 and the rate of reimbursement is extremely low,
    And I feel it is because the insurance company does not know of the extent of the drugs being tested.

  6. #6
    Default
    robertjsenese, I would discuss with the billing department of the lab what type of testing they are performing and work out if your practice or the lab should be billing for this service.

    Typically you can not purchase a high complexity definitive testing and then rebill through a practice who does not have lab accreditation to perform that level of testing. And they might be just doing immunoassay testing with reflex of confirmation testing for the positive results or straight immunoassay with additional testing methods which would fall under presumptive for certain drug classes but that would need to be confirmed with them and determining that appropriate party that should be billing for that testing given they are performing it.

    You did not indicate the type of testing you are performing prior to sending it to the lab such as drug test kit or you are just collecting the specimen. Additionally what type of test is the physician ordering and how does that correspond with the lab's requisition. CPT 80300 would fall under using point of care drug test kit (ie, cup). CPT 80301 would represent an instrumented test system. I would review with what is being ordered and the test method provided.
    But certain carriers have rules against "pass-through billing" as seen below from this BCBS carrier:

    "As a reminder, pass-through billing is not allowed. Physicians should only bill for services that they perform themselves. The laboratory performing the tests should submit the claims, not the physician?s office ordering the tests."

    80300
    Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service


    80301
    Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service

  7. Default
    80353 Cocaine: Benzoylecgonine
    80356 Heroin metabolite: 6-MAM
    80357 Ketamine and norketamine: Ketamine, Norketamine
    80358 Methadone: Methadone, EDDP
    80359 Methylenedioxyamphetamines: MDA, MDEA, MDMA

    That is a list of a few of the drugs being tested by the confirmation lab
    OUT OF NETWORK pricing.

    I have two questions:
    1) should I be using 3 units for 80359, and 2 units for 80358,
    or is it okay to just bill one unit for 3 drugs/ 1 unit for 2 drugs?
    In other words, should I price 80359 at $150 for 1 unit, or 80359 $50 with 3 units.

    2.) Should I be using just 304.90 and V71.09,
    OR should I be using an ICD which crosswalks with each code,
    304.90, 304.00, 304.40, V71.09

    Thank you so much!

  8. #8
    Location
    Denver Colorado
    Posts
    284
    Default
    All of the new 2015 CPT codes for definitive drug testing have a maximum of 1 unit of service that should be billed.

  9. Default
    There is no G Code for Ketamine, or Alcohol Biomarkers,

    How should I be billing that 84999?
    and if so, where do i enter the short string on an electronic claim (in collaborated) to show which drugs are being tested.

  10. Default HELP - CPTs 80301/80302 & type of CLIA certification
    Hi, Robert,
    hope you can help me out as I am having a hard time finding the discussion on whether CPT 80301/80302 is/are CLIA waived test (s) and what would be the proper CLIA certification a office based practice must hold to perform/bill CPT 80301/80302. Thank you in advance for your answer.




    Quote Originally Posted by dwaldman View Post
    robertjsenese, I would discuss with the billing department of the lab what type of testing they are performing and work out if your practice or the lab should be billing for this service.

    Typically you can not purchase a high complexity definitive testing and then rebill through a practice who does not have lab accreditation to perform that level of testing. And they might be just doing immunoassay testing with reflex of confirmation testing for the positive results or straight immunoassay with additional testing methods which would fall under presumptive for certain drug classes but that would need to be confirmed with them and determining that appropriate party that should be billing for that testing given they are performing it.

    You did not indicate the type of testing you are performing prior to sending it to the lab such as drug test kit or you are just collecting the specimen. Additionally what type of test is the physician ordering and how does that correspond with the lab's requisition. CPT 80300 would fall under using point of care drug test kit (ie, cup). CPT 80301 would represent an instrumented test system. I would review with what is being ordered and the test method provided.
    But certain carriers have rules against "pass-through billing" as seen below from this BCBS carrier:

    "As a reminder, pass-through billing is not allowed. Physicians should only bill for services that they perform themselves. The laboratory performing the tests should submit the claims, not the physician?s office ordering the tests."

    80300
    Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service


    80301
    Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service
    Thanks.

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