# Drug Screen Diagnosis Coding



## smontague (Nov 16, 2011)

Need assistance -- we currently use in-house urine drug screens to follow our patients who are being prescribed medications for long-term/chronic problems.  Currently we have been coding these we (305.92 - drug abuse, episodic) but don't feel that this is the most appropriate, because they aren't necessarily "abusing" the medication.  The only "drug-screening" code that I was able to locate is the "drug screening in athletes".  

Our thought was to change to a dual-diagnosis coding system, where we would code the drug dependence (i.e. opiate dependence) and then code the reason for the drug use (i.e. ADD, chronic pain, etc.)

Does anyone else do anything similar to this.  Looking for ideas or suggestions.  Thanks!


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## SAPERRINE (Nov 16, 2011)

Try using V58.69


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## smontague (Nov 16, 2011)

Thanks, hadn't thought of that...we use the v58.61 for our coumadin patients, so this makes perfect sense.  Thanks again!


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## mitchellde (Nov 16, 2011)

Actually V58.69 is a secondary only dx code as it is a status indicator only and does not convey the reason for the encounter if the test is being performed because the patient is on medication then it is not a screening it is a drug monitoring encounter so it sould be coded as V58.83 with a secondary code of the V58.69.  Same is true for the coumadin.  See coding clinic 4th quarter 2003 and 1st q 2004 I believe.


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## angesmith94 (Dec 21, 2011)

try v5883 for med. monitoring and v5869 for long term therapeutic meds.


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## anuja.devasthali (Mar 7, 2012)

*Urine Drug screen Dx*

Even we are confused what Dx should we codes with G0434. As per Medicare LCD guidelines " Report monitoring of patients on methadone maintenance and monitoring of chronic pain patients with opioid dependence suspected of abusing other illicit drugs, using V58.69 as the primary diagnosis."

From this statement it is clear that V58.69 can be used as primary Dx for urine drug screen. We did the same ( used V58.69 as primary diagnosis ) but the claim got denied stating need additional diagnosis. Even V58.83 won't work.
We can not use 304.00 ( Opioid dependence / Methadone dependence ) as V58.69 excludes it. 
Should we use V71.81 ( Observation and evaluation for other specified suspected Abuse and neglect )  as secondary code ?
Can someone suggest ?


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## mitchellde (Mar 7, 2012)

no you do not use a 304.x nor the V71.81, it is med monitoring , I have always used V58.83 followed by V58.69 with 338.29 third and I have never had any problem.


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## elizabeth24 (Mar 8, 2012)

We use the diagnosis for the reason for the drug use, such as chronic pain syndrome, back pain, etc. followed by V58.69 and have never had any problems.

We never use V58.83 prior to the codes for V58.69 or V58.61 -- is this incorrect?


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