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CPT codes 80101 versus 80104

  1. #1
    Default CPT codes 80101 versus 80104
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    In our Pain Management office we do drug screening for different drugs. We are having a disagreement as to which CPT code should be used for this. We are a CLIA-waived facility. I am getting conflicting information as to which one to use. Help and Thanks

  2. #2
    What are method(s) of testing that encompasses a drug test where you are.

    Drug test kit described recently in December 2010 CPT Assistant

    ----Per Cpt Assistant Dec 10, "multiplexed' because of the ability to qualitatively assay multiple drug simultaneously. It is effectively running multiple tests at once, in a single procedure, due to the test kit desing. Prior to 2011, the reproting was commonly reported as mutliple units of code 80101, as code 80101 was not specific to a single or multiple sequential procedures. In 2010, HCPCS code G0430 was created to describe a non chromatographic method wherein multiple drug classes were screened in a single procedure. New code 80104 more accuratley reflecting the resources used in a multiplex test kit as compared to multiple runs using a single class methodlogy.

    80101 can it still be used in 2011?

    They describe use of 80101 in the same article: "Methods then became available that relied upon immunoassay or enyzme assay in which an assay identfied the presense or absence of drugs within a single class. Each test run was for just one class and code 80101 Drug screen, qualtative; single drug class method (eg immunoassay, enzyme assay), each drug class.

  3. #3
    Thank You so much as always for your response, but I now have another question. If the test is done in the office with a drug kit and then to the lab for further testing would you use the new CPt code 80104-GW with one unit or 80101 with mulitple units?

  4. #4
    You would need to contact the Lab and talk to for example the toxicology director or your representative assigned to you from the lab. Say that you need to know their test method----is it?----they are testing a single drug class using immunoassay or enzyme assay in a single run. So in essense if they are testing five drug classes, they are doing 5 procedures. Versus testing that is other than chromographic that simulatneously tests multiple drug classes. I think once you have in writting what type of testing they are doing then you confirm the appropriate code to bill. We also have the same scenario you are describing of doing the drug test kit as "initial field test" then sending the specimen within the kit to the lab so they can provide a report do their style of testing. We are in process of confirming what type of testing they are performing. Still a lot to review before we will be able to bill for any drug tests for 2011. Sending to the lab and doing our own billing makes a lot more in depth understanding that we are still looking to acquire.

    It is interesting that you can go back eleven years a look at the CPT Assistant article for drug testing and things that I did not pay much attention to when it was just 80101 x classes. Now I am trying to better understand it when there are more codes, more involvement with AMA and CMS with modifications, and still more questions.
    __________________________________________________ ________
    2010 CPT Assistant March

    For example, immunoassays, which are used to identify single drug classes, should be coded using 80101 (when used in drug screening), whether the test is performed using a random access analyzer, a single analyte test kit, or a multiple analyte test kit. Chromatography, which can identify multiple drug classes, is coded using 80100 (when used in drug screening).

    For code 80100, each combination of stationary and mobile phase is to be counted as one procedure. For example, if screening for three drugs by chromato-graphy requires one stationary phase with three mobile phases, report 80100 three times. However, if multiple drugs can be detected using a single analysis (eg, one stationary phase with one mobile phase), report 80100 only once.

    For code 80101, each single drug class method tested and reported is to be counted as one drug class. For example, if a sample is aliquoted to five wells and separate class-specific immunoassays are run on each of the five wells and reported separately, report 80101 five times. Similarly, if a sample is run on a rapid assay kit comprising five class-specific immunoassays in a single kit, and the five classes are reported separately, code 80101 should be reported five times.

    80101, Drug, screen; single drug class, each drug class. A 30-year-old female, with a history of anxiety and depression treated with prescription medications, comes to the ED in a coma. The treating physician orders a drug screen for alcohol, barbiturates, benzodiazepines, phenothiazines, and tricyclic antidepressants. The laboratory performs single drug class screening for each analyte using immunoassay or enzyme assay methods in a random access analyzer.

    To code this you would use 80101 times five, because this code is used to report immunoassay and enzyme assay, single drug class methods. Five units are reported as each single drug class is reported separately.

    80101, Drug, screen; single drug class, each drug class. A 25-year-old male with a history of illegal drug use comes to the ED in a coma. The treating physician orders a drug screen for amphetamines, barbiturates, benzodiazepines, cocaine and metabolites, opiates, phencyclidine, and tetrahydrocannabinoids. The laboratory performs single drug class screening for each analyte using a multiple analyte rapid test immunoassay kit.

    To code this you would use 80101 times seven, because immunoassay single drug class methods are reported using this code regardless of platform (random access analyzer or multiple analyte test kit). Seven units are reported as each single drug class is reported separately.

  5. #5
    At the bottom of my response I was trying to reference CPT Assistant March 2000. But accidently typed 2010.

  6. #6

  7. #7
    You're the best and Thank You so much as always for your help. But, and you knew that was coming, I have yet another question. I spoke to our Medicare carrier and they said that at this time the CPT code 80104 is invalid and there is no fee schedule for this code. I have not checked with any of our commerical carriers, so my question is, should we check with our commerical carriers to see whether they are using the CPT code 80104 and what their fee schedule is or for the commerical carriers should we continue to use CPT code 80101Q? I know this is more of a billing question, but your answer would be greatly appreciated.

  8. #8
    St. Joseph County, Indiana
    Medicare doesn't accept the 80101 or 80104 codes effective April 2010. Refer to the G0431 adn G0434 codes.

  9. #9
    St. Joseph County, Indiana
    Also a quick word about what the confirmation lab is billing versus your office:

    As you know, there are the two types of tests for drug screens - qualitative and quantative. Qualitative (described by the 80101, 80104, G043...) are the quick yes/no tests. Pain specialists use these because they give a reasonably accurate result (70 - 85% accurate depending on who you ask), right there in the office when the physician has a script pad.

    Quantitative screens can only be performed by a reference lab with a very expensive Gas chromatography-mass spectrometry (GC-MS) machine. The quantitative gives actual numbers to describe drug levels.

    The problem: Some reference labs try to bill the qualitative AND the quantitative. They make some kind of argument that they "have to" in order know what tests to run...yada yada. It's wrong. I have used six labs over the years (Ameritox, Millenium, E-Labs, Forensic Diagnositics, Forensic Fluids, and Avee). Two have tried to bill the qualitative. I fired them both. Make sure that your standing orders clearly state that if your office is billing the qualitative, they are not. Keep in safe place for when (not if) Medicare audits the lab.

    Side reference lab issue: Also don't believe the hype from labs that every qualitative needs to be confirmed by them. My clinics test every new patient and established patients 1 - 4 times a year based on a risk scale. If you have a patient's with a very low risk of abuse and diversion..and the qualitative screen comes back clean, you don't have to confirm them. We confirm 60% of all qualitative screens.

  10. Default 80104
    great discussion. what practices are confused about at this time is that Medicare has allowed practices to bill for G0431 if they are a high complex laboratory (reimbursement around $100) and commercial insurance has not defined or created a code/reimbursement for a high complex lab. typically, as we all know, commercial payers follow suit with medicare on a majority of all codes. commercial payers are now rejecting 80101 and telling practices to bill 80104 instead with reimbursement at around $20.

    by not defining a code for a high complex laboratory, commercial carriers have created a real gray area for billing for commercial qualitative drug screens.

    has anyone spoken to the commercial carriers on plans to match the medicare code G0431for a high complex lab?

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