LCD Reference Article Response To Comments Article

Response to Comments: Urine Drug Testing

A59460

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59460
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Urine Drug Testing
Article Type
Response to Comments
Original Effective Date
10/08/2023
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

The comment period for the Urine Drug Testing Local Coverage Determination (LCD) began on 04/27/2023 and ended on 06/12/2023. The notice period for L36707 begins on 08/24/2023 and will become effective on 10/08/2023. 

Response To Comments

Number Comment Response
1

ACLA would like to provide one comment on the Coverage Indications, Limitations, and/or Medical Necessity section and the discussion about the use of an Opioid Risk Tool. ACLA agrees that orders for urine drug testing should be based on specific patient information that supports an indication for testing. While we fully support a practitioner’s use of any of several evidence-based risk tools when prescribing/renewing a controlled substance, specific documentation requirements often lead to inefficiencies and difficulties in obtaining this information from the ordering practitioner. The commenter-member laboratories make significant efforts to educate ordering clinicians on coverage requirements and comply with records requests related to the adjudication of claims. However, laboratories often struggle to obtain medical documentation from health care practitioners to support the medical necessity of tests that they perform in pursuant to the health care practitioners’ orders and for which the laboratories submit claims.

The ordering health care provider creates and maintains the documentation about a patient encounter that supports the medical necessity of a test, yet the performing laboratory’s reimbursement is at stake when the documentation is not provided or is insufficient. Health care practitioners have no incentive to spend extra time and resources responding to requests from laboratories or from health care plans for medical documentation. While ACLA does not recommend any specific changes to the language in the dLCDs, we look forward to working with Noridian, other Medicare Administrative Contractors, and the Centers for Medicare & Medicaid Services to find solutions to the ongoing difficulties in obtaining and transmitting appropriate medical documentation.

For clinical laboratory tests to be covered by Medicare, the medical record must contain enough information about the patient's condition to support the medical necessity of tests. The clinical laboratory must attempt to obtain the medical order at the time the beneficiary appears at the facility to receive the test(s). They can do this by asking the beneficiary to submit the medical order that includes the related diagnosis. While it is the laboratory's responsibility to obtain and submit medical documentation for the billed test(s) to Noridian or other Medicare contractors when requested, they are often unable to provide this important documentation from the medical records because the information is with the ordering doctor's office or practice. In these cases, for the laboratory to receive payment, they must request the information from the doctor ordering the test(s). Without the order or documentation such as progress notes indicating the intent to order the test(s), as well as supporting medical necessity, payment for the service(s) will be denied. 

2

Although the dLCD makes clear that ethanol is not a topic of discussion in the dLCD, the dLCD goes on to state as follows:

“Ethanol is a known drug of abuse by is routinely tested in blood, not urine. In addition, the Drug Enforcement Administration (DEA) Resource Guide states that alcohol is exempt from control by the Controlled Substances Act (CSA).”

While ethanol may be tested in blood, that should not limit the availability of testing for ethanol via urine. Testing for alcohol use via urine specimens is a necessary tool for clinicians monitoring patients in numerous settings and may be more accessible and useful than blood testing, especially for those being treated and monitored in a clinical setting for an alcohol addiction or disorder. Blood alcohol testing can be useful when levels of acute use are needed, but this method has limitations that do not align with clinical settings where abstinence is being monitored.

Aside from being an invasive test requiring a blood draw (something many clinical offices do not have skilled staff to perform), the detection windows for use are much lower for ethanol in blood (~6-12 hours window of detection) than in urine (~80 hours window of detection when monitoring urine levels of alcohol metabolites). So, as an example, patients can avoid detection when monitored via blood testing by simply avoiding alcohol the prior evening, whereas urine testing gives a more accurate indication of alcohol use.

Given the above stated clinical advantages of monitoring for alcohol use in urine vs. blood, we believe that access to this testing in urine, when deemed medically necessary by a treating clinician, is important and should be considered in any future policymaking.

This dLCD clearly states that ethanol is not a topic of discussion in this dLCD. Therefore, there is no restriction for billing ethanol by whatever means tested and payment will be based on criteria of Reasonable and Necessary, benefit category, etc.

N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
08/18/2023 10/08/2023 - N/A Currently in Effect You are here

Keywords

N/A