Pathology/Lab Coding Alert

Question: The lab performs a drug screen using a cup method, then performs a confirmation test for one positive finding. How should we code this?

Nebraska Subscriber

Answer: You don’t provide much specific information, but most “cup method” drug screens are low-complexity tests. As such, the most appropriate code choice is likely 80104 (Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure) for a non-Medicare payer, or G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) for Medicare.

If you operate a lab with a certificate of waiver under the Clinical Laboratory Improvement Amendments (CLIA), you should add modifier QW (CLIA waived test).

For the confirmation test, report 80102 (Drug confirmation, each procedure). 

Watch units: Don’t report multiple units of these codes for multiple drugs or drug classes unless the tests involve separate procedures and/or patient encounters.