Pathology/Lab Coding Alert

Find changes all the way to the chemistry section.

No kidding — the CPT® 2015 drug test changes are massive.

Not only do you need to learn nearly 120 code additions, deletions, and revisions, but you also need to understand three new sections and subsections, plus get familiar with four new tables and lists that impact your coding.

Whew! That’s a lot. And that’s why we’re here to help. Study the following two tips to get a big-picture understanding of what’s going on, then turn to “Part 2: Focus on Methods to Direct Your Drug Code Choice” on page 20 to learn more.

Tip 1: Distinguish Purpose — Therapeutic Monitoring or Abuse Testing

The first-order organizational structure of toxicology coding now resides in answering this question: Is the clinician testing for potential drug abuse, or is the clinician monitoring therapeutic levels of known prescribed drugs?

Drugs of abuse: If the testing is to screen for, or identify, potential drug abuse, you’ll turn to the new CPT® section, “Drug Assay,” with all new codes. CPT® divides the section into the following two subsections:

• Presumptive Drug Class Screening — 80300-80304, (Drug screen …). These tests screen to see if the patient possibly did or did not use drug(s) in specific class(es). Presumptive tests don’t identify a specific drug, and can’t distinguish between structural isomers (such as morphine and hydromorphone). Clinicians may order additional testing (see the next subsection) based on presumptive test results. “Notice that the presumptive test codes 80300-80304 essentially replace deleted drug screening codes 80100, 80101, and 80104 in CPT® 2015,” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

• Definitive Drug Testing — 80320-80377. Each code represents a different drug class or drug, because these tests are more specific than the presumptive tests. Definitive drug tests can identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers). Clinicians may order them as the first test, or as a confirmatory test following a positive screening drug test. In the latter case you should use one of the new definitive drug test codes instead of deleted code 80102.

Therapeutic drugs: If the clinician orders a test to monitor levels of a prescribed medication, you’ll turn to existing CPT® section “Therapeutic Drug Assays,” (80150-80299). These tests are quantitative, because the point of the testing is to evaluate therapeutic dosage as it relates to clinical response.

Tip 2: Identify the Drug/Drug Class

Now that you understand the general organization of drug testing as either presumptive, definitive, or therapeutic, you need to tackle the next step. To select the proper CPT® code for your service, you’ll need to look at the specific drugs or drug classes involved in the test. Within each type of test, the drug/drug class information will impact your coding as follows:

Presumptive: The CPT® 2015 instructions for this section include two new drug-class lists. You’ll choose the appropriate code for your lab’s work based on whether the drug class(es) tested are from List A or List B, and based on the lab method (which you can read about in Part 2). The two lists include drugs or drug classes that clinicians may commonly order for presumptive screening, such as alcohol and opiates (List A) or acetaminophen or nicotine (List B). If you don’t find your drug on either list, look in the CPT® chemistry section.

Definitive: You’ll find codes in this subsection organized alphabetically by drug or drug class, such as alcohols (80320) or oxycodone (80365).You’ve always had codes for lots of these drugs, but CPT® used to list them in the therapeutic drug assay or chemistry sections. CPT® 2015 adds all new codes in the definitive drug class subsection for common drugs of abuse, and deletes the old codes for many of these same substances from the chemistry or therapeutic drug assay sections. CPT® 2015 also provides a new table, “Definitive Drug Classes Listing,” which shows common drugs and metabolites within each drug class.

Key: The new definitive drug test codes include all drugs and metabolites in the listed drug class (unless there is a different, specific code, such as 80356 for heroine metabolite). For instance, one unit of 80361 (Opiates, 1 or more) could describe testing for codeine, dihydrocodeine, hydrocodone, hydormorphone, and morphine, which you’ll find on the definitive drug table.

Stereoisomers represent another exception to the rule of including drugs in the listed drug class. If the lab does a different test for a stereoisomer, you should report 80374 (Stereoisomer (enantiomer) analysis, single drug class) in addition to the definitive drug test code.

CPT® 2015 provides multiple codes, or “tiers,” for some definitive drug classes, with each code representing ascending numbers of drugs or metabolites tested. For instance, you should use 80327 (Anabolic steroids; 1 or 2) if the lab tests for one or two anabolic steroids, but use 80328 (… 3 or more) if the lab tests for three or more anabolic steroids. The different tiers represent additional resources required for testing additional drugs in the class, explained Kaye Jones, representing the American Clinical Laboratory Association at the CMS annual clinical laboratory public meeting.

Unlisted: The Definitive Drug Classes Listing isn’t comprehensive, so if you find a drug or metabolite that’s not listed, you should check the FDA drug classification list to see if you can identify the drug class, and then select the appropriate drug class code. Alternately, check the chemistry and therapeutic drug assay sections to see if the drug is listed there. If you can’t find the drug any of those places, report the appropriate code from the range 80375-80377 (Drug[s] or substance[s], definitive, qualitative or quantitative, not otherwise specified; …).

Therapeutic: Similar to the definitive subsection, CPT® organizes codes for therapeutic drug tests alphabetically by drug or drug class. Also like definitive drug coding, the therapeutic drug assay codes include testing for any metabolites of the listed drug, if performed.

Tip: “With the changes in CPT® 2015, the therapeutic drug section now describes testing for prescribed therapeutic drugs, but not for therapeutic drugs that are being used for abuse — use the definitive drug testing codes 80320 thru 80377 for that,” Dettwyler says. For instance, for a patient taking prescription carbamazepine, report a therapeutic drug assay as 80156 or 80157 (Carbamazepine …). But for a test for “use or non-use” of non-prescribed carbamazepine, report 80339 (Antiepileptics, not otherwise specified; 1-3). You can see from the Definitive Drug Classes Listing that carbamazepine is in the drug class “antiepileptics, not otherwise specified.”

Little else changes in the therapeutic drug assay section this year, except some deleted codes for substances that now appear only in the definitive drug assay subsection. Also, CPT® 2015 adds a “free” code option for digoxin (80163, Digoxin; free) and valproic acid (80165, Valproic acid [dipropylacetic acid]; free).

Unlisted: If a clinician requests levels of a therapeutic drug that isn’t listed in the therapeutic drug section or in the definitive drug assay or chemistry sections, report 80299 (Quantitation of therapeutic drug, not elsewhere specified). CPT® 2015 revised 80299 to refer only to therapeutic drugs.