Primary Care Coding Alert

Question: What diagnosis code should I assign to an 80305 urine test after a patient tests positive for heroin use but the provider does not diagnose the patient with heroin abuse or heroin dependence?

Alaska Subscriber

Answer: If your provider administers 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) to a patient, and the result comes back positive for heroin use, you can only use a diagnosis that your provider has documented. In this scenario, as your provider has not documented heroin dependence or heroin abuse, you will have to rule out any code from F11.1- (Opioid abuse) or F11.2- (Opioid dependence).

This leaves you with a choice of diagnosis from F11.9- (Opioid use, unspecified). And, unless your provider has documented that the patient is intoxicated or suffering from an opioid-induced disorder, the most likely choice will be F11.90 (Opioid use, unspecified, uncomplicated). However, you should confirm with your provider that this diagnosis code is the one that best matches their intention in this situation.