Pathology/Lab Coding Alert

Question: Our lab performed a drug test using LC/MS-MS for three analgesic drug classes for a Medicare beneficiary. How should we code the test?

Alabama Subscriber

Answer: For a Medicare beneficiary, you must use an appropriate HCPCS Level II code for drug testing. In your example, the appropriate code is G0480 (Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed).

Medicare doesn’t recognize the CPT^® codes in the Definitive Drug Testing section, so you should not report 80330 (Analgesics, non-opioid; 3-5) for the test you describe.

The other similar codes that Medicare accepts for testing different number of drug classes follow:

• G0481 (… 8-14 drug class(es), including metabolite(s) if performed)
• G0482 (… 15-21 drug class(es), including metabolite(s) if performed)
• G0483 (… 22 or more drug class(es), including metabolite(s) if performed)