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!