Dorothy Posted Fri 19th of July, 2013 20:32:00 PM
What CPT should be used when a negative drug screen is "confirmed" with a method having a lower cut-off?
SuperCoder Answered Mon 22nd of July, 2013 00:18:31 AM
Confirmation of drug testing (80102) is indicated when (1) the results of the qualitative screen are presumptively positive or (2) results of the qualitative screen are negative and this negative finding is inconsistent with the patient's medical history. 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.
In addition routine confirmation (quantitative) of drugs screens with negative results is not covered by Medicare. Confirmatory testing is covered for a negative drug/drug class screen when the negative finding is inconsistent with the patient’s medical history or current documented chronic pain medication list.
These codes are to be submitted for commercial payers: – not covered for Medicare and Medicaid (verify with individual Medicaid Carriers).
Note: There are private payers that have adopted the G codes.
CPT 80100 Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
Use 80100 for each multiple drug class chromatographic procedure.
For chromatography, each combination of stationary and mobile phase is to be counted as one procedure. (If multiple drugs can be detected using a single analysis, [one stationary with one mobile phase] report 80100 once.)
If detection of three drugs by chromatography requires one stationary phase with three mobile phases, report CPT 80100 three times.
CPT 80101 Drug screen, qualitative; single drug class method (e.g. immunoassay, enzyme assay) each
Billable with a count of one for each single drug class method/each drug class, capped at a maximum of 5 units per date of service (some payors, more or less). (For qualitative analysis by multiplexed screening kit for multiple drugs or drug classes, use CPT 80104).
CPT 80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each
Submit to report a specific drug screen, qualitative analysis by multiplexed method for 2-15 drugs or drug classes (e.g., multidrug screening kit). Bill once with a count of 1.
Use 80104 to report a specific drug screen, qualitative analysis by multiplexed method for 2-15 drugs or drug classes (e.g. multidrug screening kit).