Pathology/Lab Coding Alert

Get ready for new options later this year.

When your lab performs a screening drug test, you can’t expect to get the same diagnosis code every time.

Instead, the reasons clinicians order a drug screen are as varied as the drugs themselves — and your code choices are about to get even more varied when ICD-10 goes into effect on Oct. 1.

Check Out These Crosswalk Options

Medicare and many other payers cover drug screening only for patients with history, signs, symptoms, or conditions that demonstrate medical necessity for testing. For instance, payers may cover drug screening for patients with long-term pain medicine use, or individuals showing signs of drug-induced mental or physical impairment, or a history of drug abuse. Labs may also get orders from employers for drug screening, but these aren’t covered by insurance.

The vast array of reasons that you might perform a drug screen in your lab means you’ll see a vast array of diagnosis codes — which various payers may or may not cover. Jump start your ICD-10 coding by looking at some common ICD-9 codes used to order drug screening, and their ICD-10 equivalents:

• 304.90 — Unspecified Drug Dependence Unspecified Use

Crosswalks to ICD-10 F19.20 — Other psychoactive substance dependence, uncomplicated

• 780.09 — Alteration of Consciousness Other

Crosswalks to an ICD-10 code such as R40.0 (Somnolence) or R40.1 (Stupor)

• 977.9 — Poisoning by Unspecified Drug or Medicinal substance

Crosswalks to more specific ICD-10 codes T50.901-T50.904 (Poisoning by unspecified drugs, medicaments and biological substances) that identifies the mode of poisoning as accidental, intentional self-harm, assault, or undetermined

• V15.81 — Personal history of noncompliance with medical treatment presenting hazards to health

Crosswalks directly to ICD-10 Z91.19 (Patient’s noncompliance with other medical treatment and regimen), although more specific codes exist, such as Z91.120 (Patient’s intentional underdosing of medication regimen due to financial hardship)

• V58.69 — Long term [current] use of other medications

Crosswalks to ICD-10 Z79.891 (Long term [current] use of opiate analgesic) or Z79.899 (Other long term [current] drug therapy)

• V70.4 — Examination for medico-legal reasons

Crosswalks to ICD-10 Z02.83 (Encounter for blood-alcohol and blood-drug test).