Providers performing validity testing on urine specimens utilized for drug testing shall not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed.
This is a long-standing source of confusion for providers. But now providers who try to report specimen validity testing for drug tests are more likely to be accused of unbundling because specimen validity testing is included in the descriptors for the eight drug testing codes (80305-80307, G0659 and G0480-G0483). For example, here's the descriptor for presumptive drug screen 80305:
Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
And for definitive test G0659:
Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes.
Keep in mind that strong evidence of overutilization is responsible for the constant changes to drug screen codes. Providers should assume that their Medicare administrative contractors are keeping a close eye on these claims. And
a series of fraud cases centered around lab tests have investigators interested.
But even if the payer denies attempts to bill specimen validity for a drug test, the claims indicate the practice isn't paying close attention to the rules. And if by chance it didn't deny the claims, the practice still needs to return the money.