Patients may need urine drug screening tests for a variety of reasons including monitoring of their pain medication regimen or simply as a screening tool to look for the presence of drugs. It's important to understand the types of drug screens and why one would need them prior to investigating any issues involving these tests. 

There are two types of drug testing procedures - Qualitative and Quantitative.  Qualitative drug screens are testing for the presence or absence of a particular drug.  Quantitative drug screens are testing for how much of that substance is present. 

Some of the typical procedure codes for qualitative drug screen tests (both CPT and HCPCS) include:

G0431: Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter.

G0434: Drug screen, other than chromatographic; any number of drug classes by CLIA waived test or moderate complexity test, per patient encounter.

80100: Drug screen, qualitative; multiple drug classes chromatographic method, each procedure.

80101: Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class.

80102: Drug confirmation, each procedure.

80104: Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure. 

What should investigators look for? 

Over the past few years, an increase has occurred in the number of labs under scrutiny for performing and billing for unnecessary and unauthorized drug tests.  Many providers reached settlements for allegations of physician kickbacks, forging doctor signatures, and patient bribery just to name a few. [1] 

Daily drug screenings and drug confirmation tests may indicate a patient is possibly going to an outpatient drug rehabilitation or substance abuse facility.  It is not common to receive these tests daily; however, refer to your plan's policy regarding the number of these laboratory tests covered in a benefit period. 

Review your data using a FWA software tool such as PostShield™ for the following: 

• Claims billed daily with any of above-mentioned procedure codes;
• Quantitative tests performed when Qualitative results were negative;
• Billing for multiple drug classes when the code description includes multiple classes;
• Providers billing excessive amounts of units for any of these tests per patient.  Note that the HCPCS codes G0431 and G0424 are defined as "per patient encounter" so a provider billing multiple units of either of these codes per member/day would likely be inappropriate. 

Providers rendering and billing for these services excessively may be performing medically unnecessary testing.  It is recommended you consult with your medical directors to determine the appropriateness of these tests.  

If you have any questions or comments, email us at [email protected]. 

REFERENCES:

[1] Settlements