2018 Pain Management CPT Changes – Drug Testing Drug Assay Test Code 80305

CPT code 80305 – this code have been revised in 2018.

Drug test(s), any number of drug classes, qualitative; any number of devices or procedures, capable of being read by direct optical observation only  (e.g., utilizing immunoassay) (e.g., dipstick, cups, cards or cartridges) includes sample validation when performed, per date of service

Use code 80305 when the procedures in which the results are read by direct optical observation. Meaning, the results a visually read. Examples of these procedures are dipsticks, cups, cards and cartridges. YOU MUST report 80305 only ONCE – regardless of the direct observation of drug class procedures performed or results on any date of service.

**** ONLY report once, regardless of the number of drug class per date of service
**** CPT code 80305 will be eligible in the physician office setting.

Let me add the Guidelines for the Drug Assay Procedures so you will have a better understanding.

(Source of Guidelines: CPT Code 2018. CPT is owned and is a Trademark of the American Medical Association)

The Drug Assay Procedures are basically divided into three subsections:

  1. Therapeutic Drug Assays – are performed in monitoring any clinical response to a known, prescribed medication. These procedures are typically “quantitative” tests and the specimen type is:
    • whole blood
    • serum
    • plasma
    • cerebrospinal fluid
  2. Chemistry – with code selection dependent on the purpose and type of patient results obtained
  3. Drug Assay – there are 2 major Categories in the Drug Assay subsection:
    • Presumptive Drug Class procedures are used to identify possible use or non-use of a drug or drug class. A presumptive test may be followed by a definitive test in order to specifically identify drugs or metabolites;
    • Definitive Drug Class procedures are qualitative or quantitative test identify possible use or non-use of a drug. These tests identify drugs and associated metabolites, if performed. A Presumptive test is not required to a definitive drug test.

Drugs or classes of drugs may be commonly assayed first by a presumptive screening method followed by a definitive drug identification method. The methodology is considered when coding presumptive procedures.

Each code from 80305, 80306, 80307 represents all drugs and drug classes performed by the respective methodology per date of service. Each code also includes all sample validation procedures performed.

Examples of sample validation procedures may include but are not limited to:

  • pH
  • specific gravity
  • and nitrie

The material for Drug Class Procedures may be any specimen unless otherwise specified in the code descriptor:

  • Urine
  • Blood
  • Oral Fluid
  • Meconium
  • Hair

The Drug Class Procedures can be QUALITATIVE:

  • Positive/Negative
  • Present/Absent

The Drug Class Procedures can be QUANTITATIVE:

  • Measured (depending on the purpose of the testing)

TAKE NOTE: When the same procedure(s) is performed on than one specimen type (eg. blood and urine), the appropriate code is reported separately for each specimen type by appending modifier 59.

Read related article here.

2017 New CPT Codes for Billing Coding Presumptive Drug Class Procedures, UDS, Urinary Drug Screening and Immunoassay | Point of Care UDT




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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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