Tired of Not Being Reimbursed for Drug Screens?


Drug testing has become a highly utilized medical diagnostic
service. As we have seen before, high utilization increases scrutiny. Insurance
companies consistently adjust their policies in response to standard medical care.
Let MPS help you adjust with these changing policies to ensure that you properly
bill for your services, and in this case, urine drug screens. There are several
reasons why urine drug screens are performed, but we want to focus on only drug
screens as it relates to controlled substances. Medicare is starting to bring a lot of
attention to opioid abuse screenings, in addition to the state requirement of
using the Prescription Drug Monitoring Program.

First, it is important to be familiar with the two types of urine
drug screens. This will help ensure that you ask the correct questions to
validate you are billing for the correct screening. Incorrect usage will result
in denials.

Immunoassay Testing: Also known as
Presumptive Testing or Qualitative Testing. These tests can be done either in a
CLIA waived laboratory or at point of care. The test results are obtained quickly.
The findings are presumptively reported as either positive or negative based on
a set threshold.

Specific Drug Identification: Also
known as Definitive Testing, Quantitative Testing or Confirmatory Testing.
These tests must be done by a CLIA moderate complexity laboratory. The test
results come back after several days. This type of test will quantify the
amount of a specific drug or metabolite found in the sample and can identify
drugs that cannot be isolated by immunoassay tests.

As always, establishing medical necessity is instrumental in
avoiding denials. Proper timely documentation includes unique clinical notes
and matching CPT and ICD-10 codes which are needed for every test. Blanket
documentation for the practice is not sufficient. Specific orders are required
for each individual patient.

When using the immunoassay testing, your documentation
should support and report a baseline screening. You can test at time of
treatment if an adequate patient history & clinical assessment of risk is
performed. Test results will be used to guide therapy, and if there is an
existing plan in place to use the findings clinically.

There must be an initial screening (qualitative test) before
performing confirmatory testing. An exception to this rule may include identifying
a specific substance or metabolite that is in a large class of drugs that is
not adequately detected by an immunoassay test. It is also important to assess the
patient’s side effects and interactions to a drug and identify any other
non-prescribed medication or illicit substance use where the clinician has
documented concerns.

Be thorough. If you’re not sure, look it up. Specificity and
complete documentation is very important. Let us know how MPS can help make
this, and any other billing issue, easier to understand.