# Urine Drug Screens and Confirmations



## jenlynarnold (Oct 1, 2013)

I am new to the speciality of Pain Management and am in the state of Tennessee. We have a moderate complexity lab and are doing the CLIA Waved Urine Quick-cup qualitative for initial drug screen using 80104 and G0434 for Medicare. If a confirmation is required we are using 80102 and my questions are this:

1.) We only do confirmation on the screening for the drug that shows an inconsistent level?

2.) Is there a maximum number of drugs that can be run with the confirmation code 80102 as we are having trouble with our claims being processed?

Any assistance would be greatly appreciated

JA


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## dwaldman (Oct 2, 2013)

Below is from some more information regarding CPT 80102 from the local coverage determination policy for qualitative drug testing from WPS Medicare J5 and AMA CPT Assistant March 2000 Reporting Drug Testing Codes. As seen both examples, they are describing for example gas or liquid chromatography coupled with mass spectrometry to support confirmation testing of the immunoassay results. You would need to look at the method you are utilizing for confirmation to see that it meets the requirements to report 80102 which to my understanding would be performed on an instrument in a lab setting.

WPS Medicare J5 LCD Qualitative Drug Testing
Confirmation of drug testing (80102) is indicated when (1) the results of the qualitative screen are presumptively positive or (2) results of the qualitative screen are negative and this negative finding is inconsistent with the patient's medical history. 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; 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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AMA CPT Assistant March  2000
Vignette #4:80102, Drug, confirmation, each procedure. 

A 20-year-old female 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).


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## jenlynarnold (Oct 2, 2013)

Ok let me rephrase this. After the Quik-Cup if medically necessary then we do a qualitative analyzation rather than the quantitative confirmation and still use CPT 80102. Is there a max number that we can do analysis on?


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## marvelh (Oct 2, 2013)

It is my understanding that to do confirmation testing, the lab must use a different method of testing from the initial test.  Most of the CLIA waived cups and analyzers use immunoassay for the method and as such the second testing would not meet the criteria for confirmation.  It would be a repeat of the intial test.


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