# A different urine drug screen question



## bearybubba2008 (Jun 5, 2014)

I have a different urine drug screening question that I need help with. I started working for a pain management clinic recently. We do urine screens in the office. They have purchased/leased lab equipment and hired a part time lab person that runs and (I think) analyzes the results. We do both qualitative and quantitative tests. The following is currently what is being billed for the drug screens: 
82145-amphetamines, 82205-barbituates, 80154-benzos, 82520-cocaine, 83992-phencyclidine, 83805-meprobamate, 83986-ph body fluid NOS, 82540 creatine, 82055-alcohol (ethanol), 83840-methadone, 83925-opiates, and then coding 80299 X 3 for ectasy, tramadol, and methampetamines. 

I'm not sure if these are correct or if we should be using the G0431 and G0434codes for these drug screens. Our office got these codes from the company they got the lab equipment from.
Any help on this would be greatly appreciated.  Thank you!


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## TriciaGahagan (Jun 11, 2014)

When billing for a Qualitative drug screen it varies which CPT codes to report depending on the carrier you're billing it to. For example, PA state work comp fee schedule only recognizes 80101 and 80104. Medicare does not recognize those codes anymore since 2010. Medicare came up with G0431 & G0434 to replace 80101 & 80104. The G-codes are billed with 1 unit only regardless of how many drugs are tested. G0434 is reported when a quick test or POC is performed. G0431 is reported when multiple drug classes are tested using a high complexity test method such as immunoassay, enzyme assay.

I work as a Bill Review Auditor for a work comp payer and I get a lot of urine drug screen bills from Pain Management providers, Orthopedic providers, and Clinical Labs. 

*MEDICAL NECESSITY IS THE MOST IMPORTANT THING. *
There so many Pain Management providers that are lacking this in the documentation. Drugs or drug classes for which testing is performed should reflect only those likely to be present based on the patient’s medical history and current clinical presentation. In other words, it is NOT medically necessary or reasonable to routinely test for substances (licit or illicit), which are not used in the patient’s treatment plan. Routine confirmation (Quantitative) of drug screens with negative results should be denied. Only confirmatory testing for a negative drug/drug class screen is allowed when the negative finding is inconsistent with the patient’s medical history or current documented chronic pain medication list.

*Documentation Requirements:*
A signed and dated physician order for clinical drug screening and/or testing is a key element of documentation required to support the billing of diagnostic services. Copies of the test results alone without a signed and dated order for the test are not sufficient documentation to support a claim for the drug screen. The lab requisition form must specifically match the number, level, and complexity of the test(s) performed. If the provider marks “custom profile” or “conduct additional testing as needed,” this is not considered to be a sufficiently detailed order which can be used to verify the specific tests the ordering physician intended to be performed.


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## bearybubba2008 (Jun 17, 2014)

Thank you, Tricia, for answering! I appreciate the help.


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## cynthia.dangerfield@bcbsfl.com (Sep 30, 2016)

*Rn, cpc*

Can someone please provide the source of the guidelines contributed by Tricia Gahagan in this thread?  I realize it's an old post, but I just discovered it...


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## KMCFADYEN (Oct 4, 2016)

Tricia's post is from 2014 and there have been changes yearly since then for Drug screen codes.

Beginning January 1, 2016, CMS deleted all 2015 drug testing
G codes and will continue to not recognize the AMA CPT codes
for drug testing. CMS created three G codes for presumptive
testing and four G codes for definitive testing.
1. Delete the following G-codes:
a. G0431, G0434
b. HCPCS codes G6030 through G6058
2. Continue to not recognize the AMA CPT codes 80300 – 80377
3. For presumptive testing, create three G codes. Only one of
the three presumptive G codes may be billed per day.
4. For definitive testing, create four G codes. Only one of the
four definitive G codes may be billed per day.
Presumptive Drug Testing
Code: G0477 Drug tests(s), presumptive, any number of
drug classes; any number of devices or procedures, (eg,
immunoassay) capable of being read by direct optical
observation only (eg, dipsticks, cups, cards, cartridges), includes
sample validation when performed, per date of service.
Code: G0478 Drug tests(s), presumptive, any number of
drug classes; any number of devices or procedures, (eg,
immunoassay) read by instrument-assisted direct optical
observation (eg, dipsticks, cups, cards, cartridges), includes
sample validation when performed, per date of service.
Code: G0479 Drug tests(s), presumptive, any number of drug
classes; any number of devices or procedures by instrumented
chemistry analyzers (eg, immunoassay, enzyme assay, TOF,
MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry),
includes sample validation when performed, per date of service.
Definitive Drug Testing
Code: G0480 Drug test(s), definitive, utilizing drug
identification methods able to identify individual drugs and
distinguish between structural isomers (but not necessarily
stereoisomers), including, but not limited to GC/MS (any type,
single or tandem) and LC/MS (any type, single or tandem and
excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (eg, alcohol dehydrogenase)); qualitative or
quantitative, all sources, includes specimen validity testing, per
day, 1-7 drug class(es), including metabolite(s) if performed.
Code: G0481 Drug test(s), definitive, utilizing drug
identification methods able to identify individual drugs and
distinguish between structural isomers (but not necessarily
stereoisomers), including, but not limited to GC/MS (any type,
single or tandem) and LC/MS (any type, single or tandem and
excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (eg, alcohol dehydrogenase)); qualitative or
quantitative, all sources, includes specimen validity testing, per
day, 8-14 drug class(es), including metabolite(s) if performed.
Code: G0482 Drug test(s), definitive, utilizing drug
identification methods able to identify individual drugs and
distinguish between structural isomers (but not necessarily
stereoisomers), including, but not limited to GC/MS (any type,
single or tandem) and LC/MS (any type, single or tandem and
excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (eg, alcohol dehydrogenase)); qualitative or
quantitative, all sources, includes specimen validity testing, per
day, 15-21 drug class(es), including metabolite(s) if performed.)
Code: G0483 Drug test(s), definitive, utilizing drug
identification methods able to identify individual drugs and
distinguish between structural isomers (but not necessarily
stereoisomers), including, but not limited to GC/MS (any type,
single or tandem) and LC/MS (any type, single or tandem and
excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (eg, alcohol dehydrogenase)); qualitative
or quantitative, all sources, includes specimen validity testing,
per day, 22 or more drug class(es), including metabolite(s) if
performed


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