Pathology/Lab Coding Alert

Question: When our lab tests a blood specimen for several possible drugs of abuse such as alcohol and amphetamine, should we code each drug, such as 80320 and 80324?

Florida Subscriber

Answer: If your lab is performing a drug screen for several possible drugs of abuse, you should report a drug screening (presumptive) code instead of billing individual definitive drug tests.

CPT^® distinguishes presumptive and definitive drug screening codes as follows:

• Presumptive drug class screening: The tests in the range 80305-80307 (Drug test(s), presumptive, any number of drug classes, any number of devices or procedures …) evaluate the patient specimen for the presence of drug(s) in any number of drug class(es). CPT^® divides these codes based on the method: direct optical observation (80305), instrument-assisted direct optical observation (80306), or instrument chemistry analyzer (80307). You can report one of these codes only once per date of service. Clinicians may order additional definitive testing based on presumptive test results.
• Definitive drug testing: Each code in the range 80320-80377 represents a different drug class or drug, and includes all drugs and metabolites in the listed class (except for rare cases that involve a specific metabolite code). The definitive tests are more specific than presumptive tests, and can identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers). Clinicians may order definitive testing as the first test, or as a confirmatory test following a positive screening drug test.

The specific answer to your question is based on what the clinician ordered, and what analysis method your lab uses to perform the assay(s).

Caution: Most payers won’t cover the definitive drug test codes without a medically-necessary reason, such as a positive screening test, or symptoms that the clinician deems suspicious for drug overdose. Reporting a screening test for multiple drug classes as multiple definitive drug tests is fraudulent coding.