Pathology/Lab Coding Alert

Frequency and validity could trip you up.

When your lab performs drug tests, you must follow two guiding principles if you want to steer clear of compliance pitfalls.

If you report the code(s) described in "See How PLA Options Stir the Drug-Test Coding Pot," here are the tips you need to make sure you have clean claims.

Tip 1: File One Code per Day

Looking back at the code definitions for presumptive and definitive drug tests in the above article, you'll see that each code includes the phrase, "per date of service" or "per day."

In case that's not clear enough, CPT^® instruction further drives home the point. For presumptive codes 80305-80307 (Drug tests, presumptive...), the instructions tell you to report the code once "irrespective of the number of ... drug class procedures ... or results on any date of service."

For definitive testing, Medicare requires HCPCS Level II codes G0480-G0483 or G0659 (Drug test(s), definitive...). Regarding these codes, the 2018 NCCI Policy Manual states, "[G0480-G0483 and G0659] are reported 'per day' and shall not be reported with more than one UOS per day." For payers that accept CPT^® definitive drug-test codes in the range 80320-80377, there is not a date-of-service limit.

Caution: "Certain labs have been known to perform definitive testing for many drugs on a single sample and thus, greatly enhance their revenue," says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. "You must be able to demonstrate medical necessity for those tests," Dettwyler cautions. To circumvent paying for multiple definitive drug class tests, CMS requires you to bill the G-codes, which represent the total number of different drug classes performed per day.

Tip 2: Don't Separately Report Validity Testing

You'll also notice that the CPT^® code definitions for presumptive drug tests and HCPCS Level II code definitions for definitive drug tests include the phrase "includes sample validation when performed" or "includes specimen validity testing." That means you should never separately bill for additional tests that your lab performs to ensure that the specimen is unmodified urine.

To drive home the inclusion of validity testing in urine drug tests, CMS released MLN Matters number SE18001 in March. The article states, "Providers performing validity testing on urine specimens utilized for drug testing shall 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."

Modifier: If the provider separately orders one of these common validity tests for a reason unrelated to a urine drug test on the same date of service, you may bill both codes together with a modifier, such as 59 (Distinct procedural service).