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Know Your 2015 Urine Toxicology Billing Protocols

A medical or laboratory provider who performs Urine Toxicology services may find billing and collections to be a challenge based on the testing method, machine used for testing and the 2015 CPT code changes. According to Tim Tobin President and CEO of Medorizon, we find three methods of urine testing. First, we see the Point of Care Cup (POC), which is tested in office, at the point of care. This test typically will give a positive or negative determination for certain substances and typically is billed with one unit utilizing CPT Code 80300. Second, we find tests performed using a qualitative screening profile, typically with an immunoassay machine referred to as a desk top analyzer. These tests are typically submitted using CPT Codes 80301 (drug class A) as single unit, and 80302 using multiple units for each Class B substance. Lastly, urine drug testing may be performed utilizing the liquid chromatography/mass spectrometry (LC/MS) method in a High Complexity lab environment. This is referred to as a quantitative testing method and is typically ordered by a healthcare provider to insure the patient is compliant with the physician orders for prescribed medication. These Quantitative tests are billed with a variety of CPT Codes ranging from 80320 to 83992. The CPT Code sets find like type substance metabolites grouped together unlike previous coding where each substance would stand alone for evaluation and billing purposes.

According to Tim Tobin, we find the logic behind urine toxicology billing has changed significantly from 2014 to 2015”. First, we see a new set of CPT codes effective 2015 with all previous CPT codes being deleted. By not updating your practice management system, claims could be denied as the carrier may be unable to recognize the code sets. With the new CPT codes we see new groupings with different logic in submitting claims. Prior to 2015 most illicit substances and prescription medication would stand alone when billed. Now the provider and billing department must clearly differentiate between each substance and group like substances. Furthermore, with both Qualitative and Quantitative services the provider must understand Class A and B substances and units to be billed with appropriates CPT code. Many times the lab may mistake a Qualitative test and bill as Quantitative which is clearly erroneous and could lead to an audit and/or extensive fines. The AMA CPT codes clearly identify the machine and method of testing with applicable coding and fees.

In conclusion, Tim Tobin states to make certain the provider, whether a Pain Management or Behavioral Health provider understands the billing protocols and guidelines associated with the 2015 changes to urine toxicology and accurate coding and compliant billing practices.

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