Laboratory tests are a vital source of revenue for healthcare providers. Among the routinely performed tests are drug screening tests. In 2023 alone, over 70.5 million people used illegal drugs or misused their prescription medications in the USA. This clearly points to an increase in substance abuse.
CPT code 80307 is frequently used in initial drug screenings. Yet, many billers don’t know how to file claims for it properly. So, how can you avoid denials for code 80307? Well, that’s what this blog is all about.
CPT Code 80307 – Description
CPT code 80307 is defined as:
“Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, by instrument chemistry analyzers (e.g., utilizing immunoassay [EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography.”
That’s quite a mouthful, so let’s try to break this down in simple terms.
Code 80307 is mostly used in toxicology labs. It refers to a presumptive drug test. The emphasis on the term “presumptive” is essential to note. 80307 is different from “definitive” drug tests. How? Well, presumptive testing is a preliminary qualitative (yes/no) screening for the presence of a drug or drug class. On the contrary, definitive drug tests are mostly quantitative but can also have qualitative aspects.
CPT code 80307 is performed using instrumented chemistry analyzers, such as EIA, ELISA, EMIT, FPIA, IA, KIMS, and RIA, to detect and measure specific substances. The test results from 80307 usually serve as an initial screening tool.
Scenarios Where CPT Code 80307 is Applicable
Still confused? Let’s help you understand the code’s usage with some real-world scenarios. The most common use of CPT code 80307 is in substance overuse or abuse cases. So, let’s discuss a couple of them:
Alcohol Abuse
Suppose a 35-year-old man comes to the hospital. He is showing signs of anxiety and tremors in his body. The patient also admits to consuming a lot of alcohol daily for the past 6 months, often to the point of intoxication. This clearly points to severe alcohol abuse, requiring proper treatment.
However, to assess the patient’s current alcohol level and intoxication, a drug test is necessary. So, the physician orders a comprehensive drug test including alcohol metabolites. At the end, the medical billing department codes and submits the claim for reimbursement. In this case, CPT code 80307 is used along with the primary diagnosis code F10.12 for alcohol abuse with intoxication.
Abuse of Laxatives
Suppose a 28-year-old female comes to the ER. She has chronic diarrhea and a severe electrolyte imbalance. The patient also lost significant weight in the past few months. During consultation, the patient reluctantly admits to excessive laxative use for weight control purposes, consuming multiple doses daily despite experiencing adverse effects.
These symptoms suggest harmful non-dependence-producing substance abuse. However, to confirm the presence of laxative compounds and assess the extent of abuse, the physician orders specialized drug screening. In this case, the billing team can file a claim with CPT code 80307.
Applicable Modifiers for CPT Code 80307
CPT code 80307 is used as an initial drug screening test, and in most cases, it does not require any modifiers.
However, you should keep in mind some key guidelines.
- 80307 does not qualify as a CLIA-waived test, so do not use modifier QW with it.
- If both a presumptive and a definitive drug test are billed on the same day, the second test will be subject to NCCI edits. This applies if the definitive test is medically necessary. This means that an appropriate NCCI modifier, like XE or XU, must be added to its billing code.
CPT Code 80307 – Billing & Reimbursement Guidelines
Insurance payers need a single reason to deny your claim. Therefore, don’t give them any opportunity! The following are some important things that you must keep in mind while filing claims for CPT code 80307.
Required Documentation
- All paperwork must be saved in the patient’s file and shown to insurers when asked.
- Every page must be easy to read, have the complete patient name, and the date of service.
- Documents must also mention the physician or non-physician practitioner who treated the patient.
- The diagnosis codes must support the provided medical records and accurately represent the patient’s condition.
- The billing codes must match the actual services provided.
- The medical records must clearly mention the reason for performing the drug test.
- The physician’s order for the drug test must be in the file and clearly mention all the drugs and drug classes that were tested.
- The lab physician performing the test (other than the ordering physician) must maintain a copy of the lab results (hard copy) and include the medical necessity of the drug test.
Frequency Limitation
CPT 80307 can be reported only once per date of service, regardless of the number of drug classes tested. This single-unit billing approach differs significantly from other laboratory procedures.
Medicare Reimbursement
CPT code 80307 has a status indicator “X” as outlined by CMS guidelines. This means that Medicare does not reimburse this code under the Physician Fee Schedule. However, CMS has included this code in the Clinical Laboratory Fee Schedule (CLFS), under which it is reimbursable. Under CLFS, code 80307 has a national reimbursement rate of $62.14.
Wrapping Up
Let’s revisit all that we learned in this guide. We told you that CPT code 80307 is used for a presumptive drug screening test. The test is conducted via instrument chemistry analyzers, chromatography, and mass spectrometers. Additionally, in most cases, the use of modifiers is not necessary.
We have attempted to simplify this code to the best of our ability. However, if you are still facing claim denials or administrative overheads, the easiest solution is to outsource your billing to professional companies like MediBillMD. We offer comprehensive toxicology lab billing services, guaranteeing a revenue boost.
