You would want to also review the up and coming drug testing codes for 2015. I have copy and pasted these below. Purchasing AMA CPT Changes 2015 could assist with this. For example, in contrast to reporting 80101 per drug class,
CPT 80301 will be reported with 1 unit. And additional classes that are ordered from drug class list B under 80302 will be reported per procedure. You need to review the Local Coverage Determination policy for the Medicare carrier to see ICD-9 codes that meet medical necessity. For example, V58.69 is the only relevant code that is supports monitoring chronic pain patients with long term or current use of opioids. Below this is specifically described in the WPS Medicare J5 LCD. ICD-9 codes for the location of pain itself does not correlate the reason for the testing and I think you will find when you review your LCD, would not be covered.
- determine the presence of other substances prior to initiating pharmacologic treatment
- detect the presence of illicit drugs
- monitor adherence to the plan of care
You mentioned adulteration testing (Oxidants, PH, Urine Creatinine)
CPTs such as 81005, 83986, 82570 are known to be reported for adulteration testing. But certain LCDs for Medicare contractors might have specific instructions preventing additional payment for this type of testing and find in inclusive into the payment for the primary testing.
Below is from laboratory PDF describing the high complexity testing requirements that is granted to be able to report HCPCS G0431. There is an additional information regarding point of care testing using G0431 in this setting versus a laboratory setting.
5) What is a High Complexity test according to CMS?
According to CMS code G0431 now applies to a high complexity test only. This test is specific to its FDA approved complexity in its 510(k) application. A high complexity lab must perform this test. The personnel required in this lab must meet the specified CLIA Clinical Laboratory Personnel Requirements.
http://www.alfascientific.com/wp-con...-Jan.-2011.pdf
http://www.palmettogba.com/palmetto...edicare~Articles~Drugs Biologicals~8Q2LHW8528
Railroad Medicare
Semi-Quantitative Drug Testing: Billing/Coding Alert
Pain Management Billers:
If you are a point-of-care provider that bills services to monitor drugs of abuse and submits a quantitative code, you may be at risk for an overpayment request.
In order to effectively treat chronic pain, physicians rely on drug testing to monitor prescribed medications and drugs of abuse. Practices may purchase or lease enzyme immunoassay (EIA) devices to provide preliminary qualitative or semi-quantitative test results for monitoring purposes. EIA devices and the reagents used to perform in-office drug testing are FDA cleared only to obtain qualitative or semi-quantitative initial screen/preliminary results.
Since an immunoassay and an enzyme assay are by definition moderate complexity tests that produce qualitative and semi-quantitative results, they may not be reported with a quantitative code. Confirmation or quantification of the preliminary result is not usually produced in a point-of-care setting.
The initial drug screen/preliminary result should be reported with HCPCS code G0434, (Drug screen other than chromatographic; any number of drug classes), by CLIA waived test or moderate complexity test, per patient encounter.
The following codes should not be reported for the initial screen/preliminary result when performed by EIA:
?HCPCS code G0431 ? Drug screen, qualitative; multiple drug classes by high complexity test method
?CPT Chemistry section, codes 82000-84999
?CPT Drug Testing section, codes 80100-80104
?CPT Therapeutic Drug Assays section, codes 80150-80299
Use of the above codes to report preliminary qualitative or semi-quantitative test results is considered systematic up-coding and may lead to criminal and civil penalties.
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Below is from AMA CPT Assistant from 2000 for CPT 80102 regarding number of units which is pretty technical if not familiar with the testing methods described or how the current instrument that will be used corresponds to these guidelines. But it is important to note that CPT 80102 will be deleted in 2015. And the definitive codes will replace the confirmation testing. Other codes that such as 82541 will be revised to prevent the reporting for LC/MS using this type of code.
Use 80102 for each procedure necessary for confirmation. As with the screening code (80100), for chromatography, each combination of stationary and mobile phase is to be counted as one procedure. For example, if confirmation of three drugs by chromatography requires one stationary phase with three mobile phases, report 80102 three times. However, if multiple drugs can be confirmed using a single analysis (eg, one stationary phase with one mobile phase), report 80102 only once.
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WPS Medicare LCD J5 for UDS
Medicare will consider performance of a qualitative drug test reasonable and necessary when a patient presents with one or more of the following conditions:
1. For monitoring patient compliance during active treatment for substance abuse or
dependence.
2. A qualitative drug screen is considered medically reasonable and necessary in patients on
chronic opioid therapy:
- In whom illicit drug use, non-compliance or a significant pre-test probability of non-adherence to the prescribed drug regimen is suspected and documented in the medical record; and/or
- In those who are at high risk for medication abuse due to psychiatric issues, who have engaged in aberrant drug-related behaviors, or who have a history of substance abuse.
3. Medicare will consider performance of a qualitative drug test reasonable and necessary in patients with chronic pain to:
- determine the presence of other substances prior to initiating pharmacologic treatment
- detect the presence of illicit drugs
- monitor adherence to the plan of care
Drugs, or drug classes for which testing is performed, should reflect only those likely to be present, based on the patient's medical history, current clinical presentation, and illicit drugs that are in common use. Drugs for which specimens are being tested must be indicated by the referring provider in a written order.
A qualitative drug test may be reasonable and necessary for patients with known substance abuse or dependence, only when the clinical presentation has changed unexpectedly and one of the above indications is met.
A qualitative drug test may be reasonable and necessary for patients with symptoms of schizophrenia suspected to be secondary to drug or substance intoxication.
Confirmation of drug testing (80102) is indicated when:
1. The results of the qualitative screen are presumptively positive.
2. Results of the qualitative screen are negative and this negative finding is inconsistent with the patient's medical history.
3. This test may also be used, when the coverage criteria of the policy are met AND there is no qualitative test available, locally and/or commercially, as may be the case for certain synthetic or semi-synthetic opioids.
A positive qualitative screen often results in an inadequate result upon which to make a proper determination. A more specific method, such as gas or liquid chromatography coupled with mass spectrometry, may be needed in order to obtain a confirmed analytical result. In particular, qualitative screens are frequently inadequate for interpretation of opiate and benzodiazepine results and therefore; quantitative testing may be needed in these instances. Confirmation testing is usually not required for drugs like methadone, wherein false positive results are rare. However, factors such as cross-reactivity with other similar compounds or interfering substances in the specimen may effect test results. Confirmatory testing eliminates the risk of false positives. Also, eliminated by confirmation, is the risk of a ?pill scraper? slipping through. Patients diverting their drug, attempt to cheat the test by scraping a bit of drug from a pill into their urine sample. It would screen positive, but there would be no metabolite upon confirmation. Frequent use of this code will be monitored for appropriateness.
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2015
Presumptive Drug Class Procedures
80300 Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service
80301 Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service
80302 Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure80303 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (eg, acid, neutral, alkaloid plate), per date of service
80304 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure
Drug Class A
Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants
Drug Class B
Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified
Definitive Drug Class Procedures
80320 Alcohols
80321 Alcohol biomarkers; 1 or 2
80322 Alcohol biomarkers; 3 or more
80323 Alkaloids, not otherwise specified
80324 Amphetamines; 1 or 2
80325 Amphetamines; 3 or 4
80326 Amphetamines; 5 or more
80327 Anabolic steroids; 1 or 2
80328 Anabolic steroids; 3 or more
80329 Analgesics, non-opioid; 1 or 2
80330 Analgesics, non-opioid; 3-5
80331 Analgesics, non-opioid; 6 or more 1 or 2
80332 Antidepressants, serotonergic class;1 or 2
80333 Antidepressants, serotonergic class; 3-5
80334 Antidepressants, serotonergic class; 6 or more
80335 Antidepressants, tricyclic and other cyclicals; 1 or 2
80336 Antidepressants, tricyclic and other cyclicals; 3-5
80337 Antidepressants, tricyclic and other cyclicals; 6 or more
80338 Antidepressants, not otherwise specified
80339 Antiepileptics, not otherwise specified; 1-3
80340 Antiepileptics, not otherwise specified; 4-6
80341 Antiepileptics, not otherwise specified; 7 or more
80342 Antipsychotics, not otherwise specified; 1-3
80343 Antipsychotics, not otherwise specified; 4-6
80344 Antipsychotics, not otherwise specified; 7 or more
80345 Barbiturates
80346 Benzodiazepines; 1-12
80347 Benzodiazepines; 13 or more
80348 Buprenorphine
80349 Cannabinoids, natural
80350 Cannabinoids, synthetic; 1-3
80351 Cannabinoids, synthetic; 4-6
80352 Cannabinoids, synthetic; 7 or more
80353 Cocaine
80354 Fentanyl
80355 Gabapentin, non-blood
80356 Heroin metabolite
80357 Ketamine and norketamine
80358 Methadone
80359 Methylenedioxyamphetamines (MDA, MDEA, MDMA)
80360 Methylphenidate
80361 Opiates, 1 or more
80362 Opioids and opiate analogs; 1 or 2
80363 Opioids and Opiate analogs; 3 or 4
80364 Opioids and Opiate analogs; 5 or more
80365 Oxycodone
80366 Pregabalin
80367 Propoxyphene
80368 Sedative hypnotics (non-benzodiazepines)
80369 Skeletal muscle relaxants; 1 or 2
80370 Skeletal muscle relaxants; 3 or more
80371 Stimulants, synthetic
80372 Tapentadol
80373 Tramadol
80374 Stereoisomer (enantiomer) analysis, single drug class
80375 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3
80376 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 4-6
80377 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 7 or more