Pathology/Lab Coding Alert

Get payers on the same song sheet.

If you’re still frustrated because you have to bill drug screening to one payer using HCPCS Level II ‘G’ codes, but to another payer using a different group of CPT^® codes, you can look for some relief in 2017.

That’s because CPT^® 2017 proposes three new codes that are virtually identical to the existing ‘G’ codes for presumptive drug tests. Concurrently, CPT^® 2017 will delete the existing drug-screen codes 80300-80304, and CMS plans to delete the three ‘G’ codes for 2017.

Sources: The AMA has released the almost-final, preproduction version of CPT^® 2017. But be aware that you may still see changes to the codes until the AMA officially releases the final version later this fall. Also, you can access the proposed code definitions (although the code numbers aren’t finalized) that CMS publicized for the Clinical Laboratory Fee Schedule (CLFS) Annual Laboratory Public Meeting held July 18, 2016 (www.cms.gov/Medicare/Medicare-fee-for-service-Payment/clinicallabfeesched/index.html click on the laboratory public meeting tab).

Watch for Payment Impact on Code Switch

The new CPT^® codes for drug screening look like this, according to the public meeting materials:

• 803X1X — Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, (e.g., immunoassay); capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service
• 803X2X — Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, (e.g., immunoassay); read by instrument assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
• 803X3X — Drug test(s), presumptive, any number of drug classes, any number of devices or procedures by instrument chemistry analyzers (e.g., utilizing immunoassay [e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (e.g., DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service.

The three new codes are “essentially the same as the ‘G’ codes G0477 through 79 … [with]… a few very minor editorial changes,” stated Paul W. Radensky, M.D. J.D., principal, McDermottPlus Consulting in his address at the public meeting.

The new codes should replace the following existing HCPCS Level II codes for presumptive drug testing:

• G0477 — Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g. immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), including sample validation when performed, per date of service
• G0478 — … any number of devices or procedures (e.g. Immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), including sample validation when performed, per date of service
• G0479 — … any number of devices or procedures by instrumented chemistry analyzers (e.g. immunoassay, enzyme assay, TOV, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.

The minor changes that you see between the ‘G’ codes and the new CPT^® codes are for clarity: for instance, expounding that some of the method examples are a type of mass spectrometry either with or without chromatography.

Price expectations: Many commentators at the public meeting suggested that CMS should price the new codes the same as the ‘G’ codes they’re replacing. Ronald McLawhon, MD, PhD, representing the College of American Pathologists, supported crosswalking the codes, stating, “Our rationale is that the [code] descriptors and resources are essentially similar.”

Delete 5 CPT^® Drug Screen Codes

The AMA preproduction file shows the deletion of the following codes:

• 80300 — 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
• 80301 — … single drug class method, by instrumented test systems (e.g., discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service
• 80302 — 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
• 80303 — 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
• 80304 — … not otherwise specified presumptive procedure (e.g., TOF, MALDI, LDTD, DESI, DART), each procedure.

Bottom line: Starting Jan. 1, 2017, you can expect to stop using codes 80300-80304 and G0477-G0479 for presumptive drug testing. In their place, you’ll have three new CPT^® codes, which should streamline your coding for drug screens, regardless of payer. Watch the pages of Pathology Lab Coding Alert for any possible updates, because these code changes are not yet finalized.