Payers Targeting 80101 Abuse for Drug Testing

Per AMA instructions, when coding for drug testing by any method other than chromatography for multiple drugs or drug classes, you should report 80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure. If qualitative methods other than chromatography are used to test for a single drug only, you should report 80101 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class. In recent years, there has been confusion on proper coding when using a “kit” containing multiple dipsticks (or cassettes, cups, etc.), each of which is used to detect a different analyte. AMA’s CPT Assistant, December 2010, explains, “Kits are commercially available for 12 or more analytes. These test kits are…. effectively running multiple tests at once, in a single procedure, due to the test kit design.”

Proper coding when using such a “multiplex” test kit is a single unit of 80104—not multiple units of 80101. Payers in California and elsewhere have begun post-payment audits of provider claims, and are demanding repayment when multiple units of 80101 were reported, but where 80104 was appropriate. Improper payments have been substantial, in many cases equaling thousands of dollars, per claim.