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Testing technique may affect tab

APCs Weekly Monitor, December 28, 2003

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TODAY'S TOPIC: Testing technique may affect tab

QUESTION: Our reference laboratory charges us varying prices for the same CPT-4 code depending on the test performed. An example of this discrepancy is CPT-4 code 80101, "Drug screen, qualitative; single drug class method, each drug class." What is the correct way to bill Medicare for these services? Are we allowed to set up multiple line items in the chargemaster with varying prices, or do we need to set one standard charge for a given CPT-4 code?

ANSWER: Drug testing codes are rather vague compared to other CPT code descriptors. In the case of the code 80101 (e.g., immunoassay, enzyme assay, each drug class) there are techniques to consider, which may vary based on what drugs they are testing for. This is the preliminary test to determine whether a certain drug is present, and a second (confirmatory) test is performed as indicated.

Consider analyzing where the charge variances are noted. Are charges higher for most common drug tests, or are the variances noted across the gamut of tests that can be reported with this group of CPT codes? If the variances do not appear to be consistent, request clarification from the reference lab.

The reference lab may be charging differently based on testing technique (e.g., immunoassay v. enzyme assay). The provider reimbursement manual states only that, when setting charges, the rates set must be uniformly applied to inpatients and outpatients. We recommend that you determine whether the variance is related to the testing method. If it is, ask the reference lab to write a letter explaining the charge variances. This would at least provide documentation as to why the hospital had different charges for the same CPT code. When creating these charges in the hospital chargemaster, identify the testing method within the test description to ensure that staff select the appropriate one. If the reference lab is billing based upon test methodology, it should report that detail to the staff so the hospital bills appropriately. See the example below:

A) Drug screen, single drug class immunoassay 80101 $55.00

B) Drug screen, single drug class enzyme 80101 $75.00

If charges are executed by an automated order-entry system tied to an auto-charging system, there may be an issue with how the application is programmed. The laboratory may not be aware of a problem unless its internal auditing procedures or an outside party catches it. Line up the facts before you initiate an inquiry, and be sure to follow through accordingly.

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