Billing/Coding Alert: Semi-Quantitative Drug Testing

Potential primary billers at risk: Pain Management 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 code G0434 ñ Drug screen other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter.