CPT Coding for Laboratory Urine Drug Screening
For comprehensive urine drug screening sent to an external laboratory (beyond point-of-care dipstick testing), use CPT code 80307 for presumptive testing or codes 80320-80377 for definitive drug testing, depending on the number of drug classes analyzed and the methodology employed.
Understanding the Distinction
Point-of-Care vs Laboratory Testing
- Point-of-care immunoassay dipsticks (performed in-office) use different CPT codes than specimens sent to external laboratories for comprehensive analysis 1, 2
- Laboratory-based testing typically involves more sophisticated methodologies including gas chromatography/mass spectrometry (GC/MS) or liquid chromatography-mass spectrometry (LC-MS), which can detect hundreds to over 1000 compounds 3, 4
CPT Code Selection Algorithm
Presumptive Testing (CPT 80307)
- Use this code when sending urine for initial immunoassay-based screening at a laboratory
- This represents qualitative detection of drug classes using antibody-based methods 2, 5
- Important limitation: Standard immunoassays have significant cross-reactivity issues and may miss synthetic opioids (hydrocodone, oxycodone, methadone, fentanyl, buprenorphine, tramadol) while reliably detecting only morphine, codeine, and heroin 2, 6
Definitive Testing (CPT 80320-80377)
- Use these codes when requesting confirmatory testing or comprehensive drug screening using chromatography and/or mass spectrometry 3, 4, 5
- Code selection depends on:
- Number of drug classes analyzed (1-7 classes: 80320; 8-14 classes: 80321; 15-21 classes: 80322; 22 or more classes: 80323)
- Specific quantitative analysis codes exist for individual drugs (80324-80377)
- These methods provide superior sensitivity and specificity compared to immunoassays 3, 4, 6
Clinical Context for Appropriate Testing
High-Yield Scenarios
- Altered mental status requiring toxin identification for acute treatment 1
- Suspected overdose or poisoning where results directly impact management 1
- Chronic opioid therapy monitoring for medication compliance 2
Low-Yield Scenarios to Avoid
- Routine screening in alert, cooperative patients with normal vital signs shows only 5% positive findings with no management changes 1
- Psychiatric evaluations where routine toxicology has only 20% sensitivity for detecting organic causes 1
- The American College of Emergency Physicians recommends focused assessment based on clinical findings rather than routine protocol testing 7, 1
Critical Pitfalls in Laboratory Testing
Test Limitations
- Standard panels miss many substances: Trazodone, many benzodiazepines, and novel psychoactive substances require specific requests 8, 5
- False positives occur with fluoroquinolone antibiotics (cross-react with opiate screens) and certain antidepressants 7, 5
- Detection windows vary: Most drugs detectable 1-3 days, but marijuana persists much longer 2
Ordering Strategy
- Specify suspected substances when ordering, as laboratories cannot test for everything on every sample 7
- Request specimen validity testing (creatinine, pH, adulterant panel) to detect diluted, substituted, or adulterated samples 7
- Confirm unexpected positive results with GC/MS or LC-MS before making clinical decisions 2, 5
Documentation Requirements
When Ordering Laboratory Testing
- Document clinical indication justifying the test (not just "routine screening") 1
- Specify medications the patient is prescribed to avoid false-positive interpretations 7
- Include demographic factors (age, sex, body mass index) that affect drug pharmacokinetics 7
Billing Considerations
- Use presumptive codes (80307) for initial screening immunoassays sent to lab
- Use definitive codes (80320-80377) for confirmatory testing or comprehensive panels using chromatography/mass spectrometry
- Do not bill both presumptive and definitive codes for the same specimen unless confirmatory testing was clinically indicated after an initial screen 2