Pathology/Lab Coding Alert

Question: We perform a seven drug-class test by immunoassay (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine metabolites, opiates, and phencyclidine) followed by a mass spectrometry/gas chromatography confirmation for any positives. How should we code this if we confirmation-test for two positives, but only confirm one positive?

Connecticut Subscriber

Answer: You should code for the work you perform, which is the same even if only one confirmation is positive.

Code the drug screen: The correct code for the drug screen you describe is 80101 x 7 (Drug screen, qualitative; single drug class method [e.g., immunoassay, enzyme assay], each drug class). Because the definition states, "each drug class," you should report seven units of the code for the seven classes tested.

Caution: If the payer is Medicare, you shouldn't report 80101 x 7. Instead, you should list a single unit of G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter).

For the drug confirmation, you should list each procedure as 80102 (Drug confirmation, each procedure) regardless of the test results. Depending on the drugs and the lab equipment, running a confirmation test for two drugs might be a single unit of 80102 or 80102 x 2.

Here's why: You stated that your confirmatory testing involves chromatography, which impacts what counts as a "procedure" -- the unit of service for 80102. According to CPT^® instruction, "for chromatography, each combination of stationary and mobile phase is to be counted as one procedure." If the confirmatory testing involves a single stationary phase and two mobile phases, you should report 80102. On the other hand, if the testing involves two stationary phases and two mobile phases, you should report the confirmatory testing as 80120 x 2.