Pathology/Lab Coding Alert

Question: We sometimes receive orders to test for multiple opiates -- maybe as many as eight. Because the 83925 definition states "opiate(s)," we have a disagreement in our lab about whether we can report multiple units, or just one. We-ve also heard that there is an MUE for this code. Could you please clarify how we should code these cases?

Arizona Subscriber

Answer: Lucky for you, a CPT 2009 code modification answers your question. The revised code (83925, Opiate[s], drug and metabolites, each procedure) adds the words "each procedure" to the old definition.

Do this: You should report 83925 for each opiate test procedure that you perform. If you separately test for eight opiate metabolites, you should report 83925 x 8, or use modifiers 59 (Distinct procedural service) or 91 (Repeat clinical diagnostic laboratory test) for the additional units, as your payer directs.

False alarm: The table that CMS recently published containing medically unlikely edits (MUEs) for units of service does not contain 83925. Based on the list, you shouldn't have a problem with an MUE edit limiting the number of units you can charge for 83925.

Caveat: The list of MUEs on the CMS Web site is not entirely complete. The published list "will consist of most of the codes with MUE values of 1-3, - [but not] MUE values that are 4 or higher because of CMS concerns about fraud and abuse," the site notes.

You can access the published MUE list on the Internet at www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage.