Applying accurate code is a vital factor when it comes to collecting reimbursements for the rendered services. Healthcare providers conduct various types of drug tests. But how will they know which code is used for which test? CPT codes will tell us that. Every drug test has its own code. CPT code 80305 represents a presumptive drug test.
Now, to find out what this test is about, how to bill this code, and what the prerequisites are that you must follow before filling a claim, you must read this guide.
CPT Code 80305 – Description
CPT code 80305 represents presumptive drug testing. Before we move forward to the details of the code, let’s understand what a presumptive drug test is. It is a quick preliminary test that screens for the potential presence of drugs or drug classes. A presumptive drug test gives a positive or negative result rather than a specific drug level or a conclusive identification. This kind of rapid testing can be used to improve patient care.
The lab analyst conducts a presumptive drug test using any technique, where the results can be read by direct optical observation alone, without the aid of an instrument, to screen for any number of drug classes on a single date. He uses tools like dipsticks, cups, cartridges, or cards for an initial evaluation to identify several drug classes. Direct reading of the results, usually in the form of color changes, provides rapid on-site drug testing.
Finding drugs or their metabolites in a patient’s body is the main objective of this process. It assists in detecting drug use, tracking adherence to medication regimens, and treating substance abuse problems.
Scenarios Where CPT Code 80305 is Applicable
There are various cases where healthcare providers use a presumptive drug test. Some examples where you can apply CPT code 80305 are as follows.
Accidental Overdose
Suppose a patient is rushed to the hospital after his family finds him vomiting. Soon after, his face turns pale, and he loses consciousness. The family reveals that a bag of white powder was found beside him. The physician suspects an unintentional overdose of opioids but wants to rule out other substances. An immunoassay cup test is performed to identify the presence of opioids, benzodiazepines, or stimulants. To bill this test, the lab can use CPT code 80305.
Opioid Therapy
Imagine a patient was on an opioid medicine for persistent back pain. He comes for a follow-up checkup when the provider decides to conduct a presumptive urine drug test to ensure the patient is taking only prescribed medications and not combining them with illegal substances. Since the provider performs this test to check if the patient is taking a prescribed amount, he can bill this test with CPT code 80305.
Pre-Employment Drug Testing
A company is hiring a 28-year-old job applicant as a watchman for the night shift. The company wants to ensure that the applicant is not addicted to illegal substances, so they tell him to undergo a pre-employment urine drug test as part of the hiring process. The drug test checks for methamphetamines, THC, cocaine, opiates, phencyclidine, and other substances if necessary. The lab technician who conducted this test may bill it using CPT code 80305, as it is a presumptive drug test required by an employer.
Applicable Modifiers for CPT Code 80305
The following are some modifiers that you can apply to CPT code 80305.
QW Modifier
The QW modifier is used to represent a diagnostic laboratory service, particularly performed as a Clinical Laboratory Improvement Amendments (CLIA) waived test. By applying this modifier, you provide evidence to an insurance payer that the test meets the requirements for CLIA waived status, which applies to simplified analysis tests performed by a lab holding a valid CLIA certificate of waiver.
Modifier 59
You can apply modifier 59 with CPT code 80305 to indicate that the drug test is distinct from other services performed on the same day on the same patient.
Modifier XE
This modifier means a separate encounter. It can be appended to CPT code 80305 if the drug test was performed at a separate patient encounter on the same day.
CPT Code 80305 – Billing & Reimbursement Guidelines
The following are the billing and reimbursement guidelines for CPT code 80305.
Ensure Correct Use of 80305
CPT code 80305 only represents the presumptive drug test, which means the goal of the test is to detect the presence or absence of drugs. However, there are other drug tests for confirmatory testing, which call for distinct CPT codes, and you can not use this code in such situations.
Furthermore, this test pertains to drug screening without automated chemistry analyzers or immunoassay analyzers. So, only use this code if the results were readable by direct optical observation, such as color changes on a dipstick.
Include Supporting Documentation
Documentation is an important aspect of medical billing. The professional must maintain every piece of paperwork in the patient’s medical file and make it accessible to the payer upon request. The lab results and copies of the referring physician’s order for the drug test must be kept in hard copy by the service provider if they are not the ordering/referring physician.
When ordering a drug test, the physician must specify the clinical indication and medical necessity. There are other things that your documents must carry, such as:
- Patient identification information
- A medical record that supports the use of the selected diagnosis code
- Reason for testing
- Provider’s order for the test
- Method used
- Results of the test
- Clinical use of the results (how it influenced treatment decisions)
- All the drugs/drug classes that were tested and identified
Follow the Frequency Limitations
The description of the code explains that a single presumptive drug test code may be paid once per patient per day. However, the frequency limits are enforced by insurers. For instance, payers usually restrict each patient to one or two presumptive drug tests per week unless there is proof of medical necessity. You must review every payer-specific policy because private insurers can differ, and negligence may lead to denials.
Conclusion
To summarize, CPT code 80305 refers to presumptive drug testing. The lab analyst performs presumptive drug test(s) by any method where the results can be read by direct optical observation, without instrument assistance, to screen for any number of drugs/drug classes on a single date.
We have covered the most important details of this code, including the code’s correct application. However, if you still find it challenging to code any service or procedure, you can always opt for professional clinical lab billing services and let experts handle the rest.
