Pathology/Lab Coding Alert

Question: We bill for urine drug screens (non-chromatographic) in our pain clinic lab using dipstick method for multiple drug classes. How should I code the tests?

Idaho Subscriber

Answer: The answer depends on the specific lab method, the payer, and your lab’s Clinical Laboratory Improvement Amendments (CLIA) licensure.

Assuming you operate the lab with a CLIA certificate of waiver, you’ll need to use a lab method and report a code on the list of approved CLIA-waived tests. It appears from your brief description of the lab method that you are performing the test using a CLIA-waived test kit.

If the lab test and the licensure are CLIA waived, you should bill as follows:

• Submit 80104 (Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure) for non-Medicare payers for a drug screen test using a cup, cassette or dipstick that tests for multiple drugs/drug classes with one test kit, i.e. a cup that tests for 9 different drug classes. Bill just one unit.
• Medicare and some commercial payers require G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) for providers with either moderate complexity or CLIA-waived certified labs that perform drug screen tests. If the lab is moderate-complexity certified and the test method is moderate complexity, the provider would report G0434 with 1 unit of service. If the lab is CLIA waived and the test method is also considered to be CLIA waived, report G0434-QW (CLIA waived test) with 1 unit of service.

There are other drug test codes for more complex lab tests that you’re probably not performing in a pain clinic setting.