Pathology/Lab Coding Alert

Learn presumptive and definitive categories.

If you’re like many lab coders who find the current CPT® options for drug-test reporting confusing, you might be happy about big changes coming down the pike.

Read on to get a sneak peek at which current CPT® drug-test codes will get the ax next year, and how more than 60 new codes will remake the drug-test coding landscape. 

Caution: The 2015 CPT® code changes aren’t finalized, but you can learn about the proposed codes from the AMA Website at www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-summary-panel-actions.page. 

Information is also available from CMS, which held the annual clinical laboratory public meeting for new codes on July 14. CMS will determine the basis of payment for the new codes using comments from the meeting, according to CMS representative Glenn McGuirk, speaking at the event. You can access the proposed codes now, and the basis of payment when available, at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Laboratory_Public_Meetings.html.

Check Out Presumptive Drug Class Screening

CPT® 2015 will delete the current drug screen codes 80100-80104 and replace them with a new section of “presumptive drug class screening” codes, as follows:

• 803XX — Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation including instrumented-assisted when performed (e.g., dipsticks, cups, cards, cartridges), per date of service
• 803XX — Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (e.g., discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service
• 803XX — Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (e.g., ELISA) or non-TLC chromatography without mass spectrometry (e.g., GC, HPLC), each procedure
• 803XX — Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (e.g., acid, neutral, alkaloid plate), per date of service
• 803XX — Drug screen, any number of drug classes, presumptive, single or multiple drug class method; not otherwise specified presumptive procedure (e.g., TOF, MALDI, LDTD, DESI, DART), each procedure.

Medicare had already stopped paying for 80100, 80101, and 80104, requiring that you report one of these two codes instead: G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter) or G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter).

Many commentators at the July 14 public meeting used the Medicare codes for their crosswalk recommendations for the new CPT® drug screen codes. For instance, “For the first [new] presumptive code for a direct optical observation procedure, we recommend a crosswalk to G0434,” said Kaye Jones, at the meeting, representing American Clinical Laboratory Association (ACLA).

Look for ‘Definitive’ Changes, Too

CPT® 2015 will add nearly 60 new codes for “definitive drug testing,” which are quantitative assays. Each code represents a drug class and a number of drugs tested. For instance, there are two codes for Anabolic steroids; … 1 or 2, and … 3 or more.

Although all of the definitive drug-test codes are new, they don’t necessarily represent new tests that you don’t currently report. In fact, CPT® 2015 deletes more than 20 codes from the existing therapeutic drug assay and chemistry sections, effectively moving these tests to the definitive drug testing section.

For instance: CPT® 2015 will delete 80154 (Benzodiazepines) from the chemistry section and add two new codes to the definitive drug testing section: 803XX (Benzodiazepines; 1-12) and 803XX (Benzodiazepines; 13 or more).