1. Drug screen coding and billing
Marsha S. Diamond, CPC, COC, CCS, CPMA, AAPC Fellow
11/20/2018 Greater Orlando AAPC

2. MEDICARE AND 3RD PARTY GUIDELINES
Do not cover drug screening/drug testing for routine purposes
Do not cover drug screening/drug testing on pre-defined basis as part of a drug contract (i.e. pain management)
Must be medically necessary
Must be documentation that provider believes patient is using/not using medications as prescribed, or using other narcotic medications not prescribed
Dx codes must reflect medically necessity for specific services
Patient typically prescribed drugs or suspected of non-prescribed drugs

3. DRUG SCREENING (presumptive Testing)
Identifies drug/drug classes present in the blood only, no quantitative analysis is reported
Drug screening covered for at point of collection (POC) or drug screen laboratory, however, covered only once
Drug screen codes are the same for Medicare/third party carriers
Code is assigned based on all drugs/drug classes by respective method per date of service
80305 direct optimal devices/procedures
80306 immunoassay, instrument assisted
instrumentation with chemistry analyzers (ELISA, others)

4. DRUG CONFIRMATION (Definitive Testing)
Confirmation or Definitive testing is ONLY billable when there is an inconsistent result between the medications prescribed and the screening results
Each category of drug class, including metabolites, is counted once per date of service
Only those tests from the definitive drug testing category are assigned when evidence indicates further testing (i.e. definitive drug testing) was necessary in order to establish final results due to inconsistency of presumptive screen and medications prescribed
Some carriers allow for “speciation” or opiates and benzodiazepines*
One code per class per facility per date of service

5. OPIATE AND OPIOID DEFINITIVE CODES
or more opiates Opioids, or more Oxycodone/Oxymorphone

6. Common drugs in opiate/opioid classes
OPIATES
- Codeine - Hydrocodone - Morphine
- Dihydrocodeine - Hydromorphone
OPIOIDS
- Butorphanol - Dextrophan - Naloxone - Pentazocine
Desomorphine - Levorphanol - Naltrexone
Dextromethorphan - Meperidine - Normeperidine
*Refer to CPT book for listing of drugs classified to other categories

7. OTHER CONSIDERATIONS A written order must be present
If a written order is not available, the progress notation that a drug screen with specifics can be utilized in lieu of the written order
Written orders CANNOT be written after the test is performed
Attestations are not permissible for missing lab orders
Protocols are not permissible. (i.e. Standing orders perform testing quarterly)
However, protocols for lab testing groupings are permissible as long as all tests are medically necessary and there is a protocol listing what tests are included in each grouping dated during the time which the test is being performed

8. CASE SCENARIO 1 – OPIATE/OPIOID TESTING
Patient who is prescribed Codeine, and Meperidine presents to provider’s office and a urine drug screen is performed by instrument assisted optical observation for opiates and opioids, and benzodiazepines at the point of collection. Presumptive testing was positive for opiates and opioids, as well as benzodiazepines. The specimen is then forwarded with a written order to the drug testing laboratory where drug confirmation is performed. POC (Provider Office) codes/bills what presumptive testing code(s)? Drug Testing laboratory codes/bills what definitive testing code(s)?

9. CASE SCENARIO 2
Patient has been prescribed Benazepril, and Crestor. The provider believes the patient is utilizing narcotics not prescribed and orders a drug screen performed by ELISA and confirmation to be performed at the drug testing laboratory. The specimen is sent to the lab with an accompanying order. Drug screen is negative for any narcotics.
Drug Testing laboratory codes/bills what presumptive testing code(s)?
Drug Testing laboratory codes/bills what definitive testing code(s)?

10. ADDITIONAL DRUG/NARCOTICS TESTING
Same rules apply for other narcotics taken:
Written order
Protocol within date of service
Definitive (confirmation) only for those drug results that are inconsistent with expected findings
(i.e. patient prescribed medications/expect screen to be positive,
patient not prescribed medications/expect screen to be negative

11. LET’S TRY SOME DRUG SCREENING/TESTing INVOLVING ALL DRUGS
Patient prescribed Gabapentin for pain as well as Ephedrine, and Doxepin. Presumption testing is performed by instrument assisted optical observation and it is positive for Gabapentin, Ephedrine and Cocaine. Presumptive Testing Code(s): Confirmation/Definitive Testing Code(s):

12. Behavior health integration management (99484)
Requires supervision by MD or QHCP
Performed by Clinical staff
20 minutes> per calendar month
Treatment plan
Cannot be reported with 99492, (Psych Collaborative Care Mgt)
Clinical staff not required to have same qualifications as needed for psychotherapy
Can also report Chronic Care E/M or Complex Chronic Care E/M if applicable

13. Behavior Health Integration mgt Assessment
Initial assessment or follow-up monitoring including validated rating scales as applicable
Behavior health planning including revision when patients is not progressing
Facility/coordination of care (psychotherapy, counseling, etc.)
Continuing of care with designated member of care team

14. Marsha S. Diamond, CPC, COC, CCS, CPMA, AAPC Fellow
QUESTIONS/COMMENTS
CONTACT INFORMATION:
Marsha S. Diamond, CPC, COC, CCS, CPMA, AAPC Fellow
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