# Reimbursement for lab codes



## kwebsteranalyst (Dec 16, 2014)

Our Pain Management physician is looking into different types of drug testing for his patients and we are needing to know if he would get paid if billing certain codes when we are only collecting the specimen.

The codes we are looking at billing would be:
82145
82520
82570
83840
83925

Any help with this would be greatly appreciated.  We have already been using the 80101 for the single drug class but he is wanting to branch out but we are afraid these particular codes are only for the lab to bill.

Thanks,
Karla


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## dwaldman (Dec 16, 2014)

82570 Creatinine; other source 

For services on or after Jan 1st, 2015, as seen below adulteration testing such as urine creatinine will not be separately reported for Medicare or carriers that follow NCCI policies.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html


E.  Drug Testing  Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed.  The Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 16 (Laboratory Services), Section 10 (Background) indicates that a laboratory test is a covered benefit only if the test result is utilized for management of the beneficiary?s specific medical problem.  Testing to confirm that a urine specimen is unadulterated is an internal control process that is not separately reportable. 

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82145- amphetamine or methamphetamine
82520-cocaine or metabolite
83840-methadone
83925-opiates

The above codes are currently used for quantitative drug screens. If you are performing the collection of the specimen, you would not bill for a quantitative drug screen.

In 2015, the codes will be updated for quantitative drug screens by the AMA and CMS, for the AMA they will refer to this type of testing as definitive drug testing which in the 2015 AMA CPT professional edition, it states:

"Definitive drug identification methods are able to identify individual drugs and distinguish between structural isomers but not necessarily stereoisomers. Definitive  methods include, but are not limited to, gas chromatography with mass spectrometry (any type, single or tandem) and liquid chromatography mass spectrometry (any type single or tandem) and exclude immunoassays (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)."

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There has been an article put out describing point of care testing using an EIA and from a Medicare perspective, things to consider for example it states codes from the chemistry section CPT Chemistry section, codes 82000-84999 should not be reported performed by an EIA. You mentioned CPT 80101 which will be deleted and be replaced with CPT 80301/80302 in 2015. But there is a separate code such as 80104, (for 2015 CPT 80300) is for performing a drug test via a drug test cup. You didn't go into details other than collection of the specimen, in terms of what type of point of care testing you are performing or if this performed by reference laboratory. There is modifier 90 which identifies that it is a referred service. But certain carriers have restrictions against such as BCBS of OK

http://www.bcbsok.com/provider/news/2012/drug_coding.html

"As a reminder, pass-through billing is not allowed. Physicians should only bill for services that they perform themselves. The laboratory performing the tests should submit the claims, not the physician?s office ordering the tests." 

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http://www.palmettogba.com/palmetto...~Browse by Topic~Drugs Biologicals~8Q2LHW8528

Semi-Quantitative Drug Testing: Billing/Coding Alert



Pain Management Billers:
If you are a point-of-care provider that bills services to monitor drugs of abuse and submits a quantitative code, you may be at risk for an overpayment request. 

In order to effectively treat chronic pain, physicians rely on drug testing to monitor prescribed medications and drugs of abuse. Practices may purchase or lease enzyme immunoassay (EIA) devices to provide preliminary qualitative or semi-quantitative test results for monitoring purposes. EIA devices and the reagents used to perform in-office drug testing are FDA cleared only to obtain qualitative or semi-quantitative initial screen/preliminary results. 

Since an immunoassay and an enzyme assay are by definition moderate complexity tests that produce qualitative and semi-quantitative results, they may not be reported with a quantitative code. Confirmation or quantification of the preliminary result is not usually produced in a point-of-care setting. 

The initial drug screen/preliminary result should be reported with HCPCS code G0434, (Drug screen other than chromatographic; any number of drug classes), by CLIA waived test or moderate complexity test, per patient encounter.

The following codes should not be reported for the initial screen/preliminary result when performed by EIA:
?HCPCS code G0431 ? Drug screen, qualitative; multiple drug classes by high complexity test method 
?CPT Chemistry section, codes 82000-84999 
?CPT Drug Testing section, codes 80100-80104 
?CPT Therapeutic Drug Assays section, codes 80150-80299 

Use of the above codes to report preliminary qualitative or semi-quantitative test results is considered systematic up-coding and may lead to criminal and civil penalties.

If you believe your practice has made this error, it may be in your best interest to take the following actions: 
?Complete a self-audit ◦Identify incorrect submissions 
◦Contain further claim submission errors 

?Consider self-disclosure protocol ◦Self-disclosure guidelines available on the OIG website


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