Pathology/Lab Coding Alert

Question: Our lab is performing a new presumptive drug-screening test, typically for 10 drug classes, that also definitively confirms any positive results. The specimen verification for this test is different from our usual methods, such as measuring pH, but instead compares DNA from the urine to DNA from a buccal swab. Should we report G0481 for the presumptive testing and G0659 for definitive identification as we did with our older tests?

Tennessee Subscriber

Answer: The test you describe probably does not fit the definitions for the codes you mention:

• G0481 (Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA,  EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); » qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(eg), including metabolite(s) if performed)
• G0659 (Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes).

Without some additional information, it’s difficult to say for sure, but it appears that you’re using one of the new Proprietary Laboratory Analyses (PLA) tests. There are two new PLA codes that describe a drug test that combines the presumptive identification with definitive confirmation and tracks specimen identity through a DNA confirmation from a buccal swab. Each code represents a test from a specific lab, as follows:

• 0007U (Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, includes specimen verification including DNA authentication in comparison to buccal DNA, per date of service) ToxProtect™ Test from Genotox Laboratories, LTD
• 0020U (Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, with specimen verification including DNA authentication in comparison to buccal DNA, per date of service) ToxLok™, InSource Diagnostics, Agena Bioscience, Inc.

To report your test with the correct code, you’ll need to know the manufacturer. You can see that the two codes describe similar test procedures, so the key to choosing the correct code is the proprietary lab that produces the test.

For PLA codes, if two tests from different labs are virtually the same, CPT^® assigns two codes and identifies the replication with the symbol,  .