Primary Care Coding Alert

Question: What is the best way to bill for a pre-employment drug test? We would like to charge for the appointment with the physician assistant (PA), who administers the urine sample collection, using 99211 if the patient is established with our practice. Then, we would like to charge 81002 for the urinalysis itself and, in cases where the sample is non-negative, coordinating with an outside lab for a definitive test using 80305.

New Hampshire Subscriber

Answer: Billing 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional …) in encounters like these would be incorrect as your PA is not evaluating or managing a patient’s condition by simply obtaining a urine sample.

Similarly, billing 81002 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy) is also incorrect, as you are performing a drug test, not a urinalysis, in this situation.

Finally, billing 80305 (Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service) may be meaningless if the payer for the service in question is not an insurance company, who would recognize a CPT^® code such as this, but is an employer on whose behalf the pre-employment drug test is being done. Also, per its descriptor, 80305 is a presumptive rather than definitive drug test, which would be reported with a code from 80320-80377.

Consequently, your best option in such pre-employment drug screens would be to come to an arrangement with the employer directly if they are paying for the service. The agreement should explicitly state the drug-testing services you will perform on the employer’s behalf in exchange for a flat fee.