Substance Abuse Medical Billing and Reimbursement Concerns

Considering substance abuse among young Americans, cannabis or marijuana use is particularly prevalent among teens and young adults in the U.S. It is classified as a Schedule 1 controlled substance and is a mood altering drug that produces a feeling of calm and well-being. Marijuana has limited medical use for severe pain relief and other chronic conditions. It can be detected in the urine, even several months after discontinuation. Medical billing and coding for cannabis and other drugs of abuse can be rather challenging with the new highly specific ICD-10 codes. The ICD-10-CM manual lists disease conditions caused by this drug under “Mental and Behavioral Disorders due to Psychoactive Substance Use” (F10 – F19), which comes under the major head “Mental, Behavioral and Neurodevelopmental disorders” (F01-F99). For e.g. Cannabis related disorders are grouped under the F12 codes. Billable codes include:

* F12.10     cannabis abuse uncomplicated

* F12.120  cannabis abuse with intoxication uncomplicated
* F12.121 …… delirium
* F12.122 …… with perceptual disturbance
* F12.129 …… unspecified

* F12.150 Cannabis abuse with psychotic disorder with delusions
* F12.151 …… with hallucinations
* F12.159 …… unspecified

At present, medical coding for testing for drugs of abuse is based on a structure of screening or presumptive testing, followed by confirmation to confirm the screening test results. Then there is the definitive or quantitative testing that identifies the particular drug and its quantity present in the patient.
 
AMA CPT® drug testing codes (80300-80377) are not valid with CMS now. CMS’ current requirement is to submit claims for drug testing with dedicated HCPCS “G” codes. CPT defined drug classes include Amphetamines; Cannabinoids, natural; Cannabinoids, synthetic; Opiates and more. For 2016, CMS deleted definitive drug testing codes G6030-G6058 and replaced them with a few new CPT codes that are eligible for reimbursement when testing is performed in an office, laboratory or facility setting. The codes include:

* G0477 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.

* G0478 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.

* G0479 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.

However, these presumptive codes are not eligible for reimbursement for chemical dependency facilities. Reimbursement for these codes is limited to one unit per day. Only one of the three codes may be billed per day.

Speaking of substance abuse and its repercussions, a new study conducted by a team of researchers at the Western University Ontario, Canada found that teens who smoke marijuana can develop schizophrenia. Several studies have earlier found the relation between marijuana and psychosis. Hospital or laboratories perform drugs of abuse screening that helps clinicians in the differential diagnosis and treatment of a patient.

Though marijuana is known to reduce pain and induce feelings of euphoria and relaxation, large doses are also thought to induce delusions, hallucinations, and a loss of personal identity. The intoxicating effect of marijuana is caused by a psycho active substance called tetrahydrocannabinol (THC). The University of Michigan's “Monitoring the Future study”, shows that marijuana use has been growing slowly on the nation's campuses since 2006. One in every 17 college students in the United States is smoking marijuana on a daily or near-daily basis, which is the highest rate since 1980.

For the study purpose, adolescent and adult rats were exposed to THC and their behaviors were observed. It was found that these young rats exhibited substantial and persistent behavioral, neuronal, and molecular changes identical to those found in schizophrenia and other neuropsychiatric disorders. Though adult rats did not show the same changes, they also experienced social cognition and memory problems after THC exposure. Study shows both the rise in adolescent use of cannabis and also the increasing THC content in newer cannabis strains.
 
Drug screening, testing and confirmation tests under medical necessity criteria are reimbursable. Pathologists performing drug tests should submit supporting documentation including a request from the treating physician asking for clinical drug screening or testing services. Proper documentation is needed for both patient record keeping and to obtain reimbursement.

Pathology medical billing also involves reporting the services provided with accurate CPT codes. Path &lab codes are measured by the number of tests performed.  Specific codes are available for each type of drug.