Dear Valued Client,
Thank you for choosing DRUGSCAN ® for your toxicology monitoring needs. At DRUGSCAN ® , exceeding your expectations is our top priority. To help simply your experience in partnering with us, we created this guide to assist you. Our goal is to make toxicology monitoring as simple as possible for your practice.
Please contact the Customer Service Department, Billing Department, Toxicology Department and your Account Executives for answers to your questions Monday through Friday.
Your Account Executive is ___________________________________________
Your account number is _________________. When you call, please have it available so that we can expedite your requests. As your needs change, we’re happy to help you select the services that will help you achieve your new goals. Thank you again for choosing DRUGSCAN ® for your toxicology monitoring needs! To contact our customer service department, billing department or a toxicologist: Please call 800.235.4890
Sincerely,
Anthony G. Costantino, Ph.D. D-ABFT President/CEO
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ACM4223
ORDERING SUPPLIES For your convenience, you can place an supply order (supplies include, but are not limited to snapdown lid specimen cups, specimen bags, shipping materials, and requisition forms) by phone, fax, via email, or by contacting your DRUGSCAN ® account executive.
Responsive Toxicology At DRUGSCAN ® , our mission is to keep everyone in the patient care continuum safe and compliant with all regulations; providing clients with advanced technology, accurate results, and superior customer service. TABLE OF CONTENTS Ordering Supplies ......................................................................... 3 Toxicology Monitoring Supply Order Form ........................................ 4 Specimen Collection and Shipping Information ............................ 5 Completing the Requisition ........................................................... 6-7 Electronic Requisitions ..................................................................... 8 Urine Specimen Collection and Handling ......................................... 9 Oral Fluid Specimen Collection and Handling ................................ 10 Blood Specimen Collection and Handling ..................................... 11 Packaging and Shipping Specimens ............................................... 12 Viewing Reports Online ......................................................... 13-16 Interpreting the Patient Report ............................................. 17-25 Billing Information ..................................................................... 26 Letters ........................................................................................ 26-29 Most Common Toxicology ICD-10 Codes ................................... 30-31 Missing Information and Required Fields ................................. 32-34 Insurance Submission and Required Fields .............................. 35-36 Excessive Testing Policies ......................................................... 37-42 Billing and Reimbursement FAQ’s ............................................. 43-44 Clinical Information .................................................................... 45 Test Offerings ............................................................................. 46-48 Urine Test Guide ........................................................................ 49-55 Oral Fluid Drug Reference Chart ............................................... 56-57 Advanced Testing Options .......................................................... 58-59 Drug Pathways .......................................................................... 60-61 Compliance Documents ......................................................... 62-63 DRUGSCAN ® eReq Quick Reference Guide ............................. 64-66
Order By Phone: 800.235.4890 Order By Fax: 888.488.8874 Order By Email: customerservice @ DRUGSCAN.com
Please Note: Unless another method is requested and approved, all supplies will be sent via ground shipping.
DRUGSCAN® account executive contact information:
Point of Care Testing Cups: POCT cups should be ordered through your regular vendor.
Thank you for partnering with DRUGSCAN®; customer satisfaction is our priority!
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Supply Order Request
SPECIMEN COLLECTION AND SHIPPING INFORMATION Shipping is simple. DRUGSCAN ® provides clinical paks, shipping boxes, and overnight shipping labels. As per Section 1, shipping supplies can be ordered by phone, fax, email, or by contacting your DRUGSCAN ® account executive. Please Note: Unless another method is requested and approved, all supplies will be sent via ground shipping. Please allow 3-5 days for delivery of shipping supplies, including return labels Routine Pickup If you select a regularly scheduled specimen pickup, FedEx or UPS will be contacted on your behalf to arrange a time and date. It may take up to 48 hours for routine pickup to begin. If you need a pickup prior to 48 hours, wish to schedule an additional pickup, or make a change to the existing schedule, please call DRUGSCAN ® customer service at 800.235.4890. Please circle your scheduled pickup day(s) and indicate time:
QUANTITY
ITEM
Requisition Forms with panel number:
Snap down specimen kit (cup with bag)
White screw top specimen cup
Oral fluid collection device
Specimen bag – standard
Urine collection pan
DRUGSCAN shipping boxes
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Clinical Paks
Preprinted Air Bills
Pick up time:
Does your office utilize FedEx or UPS? _________________
PrN (As Needed) Pickup If you select as needed specimen pickup, please contact DRUGSCAN ® customer service at 800.235.4890 and provide the customer service representative with the tracking number located on the bottom of the shipping label. Please note shipping providers usually require at least 3 hours of notice and provide a 2 hour window for pickup. If you need assistance or have a problem, please call DRUGSCAN ® customer service. When packaging specimens for shipment: • Use only DRUGSCAN ® supplied clinical shipping boxes • Make sure all collection devices are sealed properly to protect specimens during transport .
Requester’s Name: __________________________________
Date: _________________
Account Number: __________________________________________________________________
Address: __________________________________________________________________________
Phone: ___________________________________________________________________________
Please fax completed form to DRUGSCAN customer service at 888.488.8874 or email to DRUGSCAN Customer Service at customerservice @ DRUGSCAN.com
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Completing the Requisition in 11 Easy Steps - Standard Requisition * All ordered tests must be medically necessary
Completing the Requisition in 11 Easy Steps - Custom Requisition * All ordered tests must be medically necessary
1. Select BILL TO 2. Print Patient Information 3. Select Provider 4. Print insurance and billing information and include any applicable documents 5. Print Collector Name and Collection Date 6. Select Diagnosis Codes 7. Obtain Patient Signature 8. Test Results and Order Confirmations as either: • All POS or • Individual Tests c. Order Standard Oral Fluid or Urine Screening Panel a. Select Desired Tests b. Record ALL in Office
1. Select BILL TO 2. Print Patient Information 3. Select Provider 4. Print insurance and billing information and include any applicable documents 5. Print Collector Name and Collection Date 6. Select Diagnosis Codes 7. Obtain Patient Signature 8. Test Results and Order Confirmations as either: • All POS or • Individual Tests c. Order Standard Oral Fluid or Urine Screening Panel a. Select Desired Tests b. Record ALL in Office
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( ) Dr. John Pain ( ) Dr. Jane Best
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( ) Dr. John Pain ( ) Dr. Jane Best
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Remember: Enter Last Consumption Date and note PRN, if applicable
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8a
9b
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8b
8a
Remember: Select SCREEN or DIRECTED based on Medical Necessity
9a
8b
9.
9.
8c
Remember: Enter Last Consumption Date and note PRN, if applicable
a. Select Prescribed Medications b. Check Confirm
a. Select Prescribed Medications b. Check Confirm
8c
9b
Prescribed Medications, if applicable
Prescribed Medications, if applicable
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10. Obtain Physician
10. Obtain Physician
Signature, if needed 11. Write date of collection
Signature, if needed 11. Write date of collection
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on specimen bottle seal and apply to specimen collection device
on specimen bottle seal and apply to specimen collection device
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DON’T FORGET TO ATTACH SPECIMEN BOTTLE SEAL
DON’T FORGET TO ATTACH SPECIMEN BOTTLE SEAL
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Electronic Requisitions Generated using the LifePoint system
Urine Specimen Collection and Handling
Patient Preparation No special patient preparation is required. Specimen Container Urine should be collected in the specimen collection device provided by DRUGSCAN © . Specimen Handling Urine specimens are stable at room temperature for up to 30 days after collection. Specimen Labeling Specimens must be labeled with the following information: • Patient’s full name and one other unique identifier such as: requisition number, medical record number, or patient’s date of birth. • Specimen may be sealed with a tamper-resistant seal. Minimum Volume 30 ml urine (more may be required for larger profiles or test offerings). Special Requirements To prevent leaking: • Check snap cap lids to be sure the lid is completely secured. • Check screw cap lids to be sure the lid is threaded correctly and tightened.
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Oral Fluid Collection and Handling Patient Preparation Specimens should not be collected within 10 minutes of eating or drinking. Specimen Container DRUGSCAN ® Oral Fluid Collection Device. Specimen Handling Oral fluid specimens are stable at room temperature for up to 7 days after collection. Specimen Labeling
Blood Specimen Collection and Handling Patient Preparation
STEP 1
Draw site is determined based on patient preference (if possible) or availability of vein for specimen collection. Prior to collection, draw site is prepared using cleansing agent to reduce the chance of infection. Specimen Container PEth specimens are collected in two (grey top) sodium fluoride potassium oxalate blood collection tubes. Currently not testing for blood toxicology due to lack of volume. Specimen Handling Specimens should be stored at room temperature or refrigerated and shipped to the laboratory within 2 days of collection. Specimen Labeling Specimens must be labeled with the patient’s name and one other unique identifier such as requisition number, medical record number, or patient’s date of birth. In addition, the specimen may be sealed with a tamper-resistant seal. Minimum Volume 1 ml blood required, full tube optimal. Special Requirements Special collections are required for individuals with poor veins or other complications. Collections involving hands or other alternative sites require special techniques and equipment to ensure that high quality specimens are obtained for testing.
STEP 2
insert pod into mouth
Specimens must be labeled with the patient’s name and one other unique identifier such as requisition number, medical record number, or patient’s date of birth. In addition, the specimen may be sealed with a tamper-resistant seal. Minimum Volume Full Oral Fluid Collection device (indicator turns blue). Collection 1. Open the DRUGSCAN ® Oral Fluid Collection Device. 2. Instruct donor to position collection device under the tongue and close the mouth. Important: the donor must not talk, chew on pad, or remove collection device from mouth until the indicator turns blue. 3. When indicator turns blue, instruct the donor to hold the transport tube in an upright position (the pad on bottom & blue indicator on top). 4. Ask the donor to uncap the transport tube by pushing the red cap up with thumb. 5. Ask donor to insert collection device pad down, into the uncapped transport tube and replace the red cap. 6. Snap cap firmly for transport. Place center of specimen seal on top of tube and press down both sides. DO NOT:
STEP 3
STEP 4
STEP 5
• Stand tube uncapped on table. • Spill or empty fluid from tube.
STEP 6
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VIEWING REPORTS ONLINE The Client Portal What is My Login Information? USER NAME (Account #): FIRST NAME (all caps, no spaces); PASSWORD 6 characters Example: User Name: SD###: JOE Password: N####R
Packaging and Shipping Specimens To ensure the safe shipment of your specimens, please following these detailed instructions. Package Individual Specimens • Insert tightly-sealed specimen into the large inner section of the specimen bag • Fold the requisition and place it into the outer pocket of the specimen bag • Seal the specimen bag Prepare Specimens for Shipment • Record the following on the Specimen Manifest (if used): • Collection Date & Location • Patient Name and/or ID Number • Requisition Number • Initial as each specimen is placed into the larger specimen bag • Place the individual specimen bags into a FedEx Clinical Pak
1. To access the client login page select the “Log On” tab at www.toxmonitoring.com 2. Enter your login, user name, and password 3. Click on the “Get Results” tab
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• At the end of each day of collection: • Place the Specimen Manifest in the FedEx Clinical Pak with the specimens • Seal the large bag • Place the shipping label on the large bag
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Please Note: Login once and view multiple office results
For support contact DRUGSCAN® customer service at 800.235.4890 or customerservice@DRUGSCAN.com
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4. Complete any of the following to find a report: • Client account • Click on the red calendar to set the date range • Click the circle to select date type (Collect Date, Received Date, Report Date) • Enter patient’s name (last name, first name) 5. Select the circle that describes the report type (We highly recommend you select “View All Reports”) 6. Click to search for negative or non-negative
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7. To view a Single Report Click Report 8. To view a Req Image Click Req Image 9. Select Reports to view individually 10. Deselect in one click
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The Report or Req Image will open in a new window. Click on the “X” in top of the window to close the Report and go back to search results. To View a Report or Req Image: • Open Adobe Acrobat • Turn off you pop-up blocker To View a Zipped File: Open the Download Directory and click on the file
Remember: Not all elds are mandatory. The more elds you complete, the more narrow the search.
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INTERPRETING THE PATIENT REPORT
1. Requestor
Ordering clinician’s name, account name and address.
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2. Patient
Patient name, ID, gender, date of birth, and number of previous tests.
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3. Reference
Requisition ID, accessioning ID, and collection, received, and reported dates.
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Please Note: After the customer views a report the status is updated to viewed. There will be a check mark in the viewed box. To change the status, click the viewed box that correlates to the report. 11. Go Back to search screen 12. Select “All” in the search 13. Click “View Reports” to view the PDF of the report(s) selected 14. Select “Download Reports” for a .zip file of the selected reports
4. Profile Ordered
Requested test codes and description, and re ex tests ordered codes and descriptions. 5. Prescribed Medications List of prescribed medications, dosage schedule, and date of last dosage taken as per the requisition.
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6. Summary Results
For quick and easy review, results are summarized with comments. Positive confirmation of prescribed medications will be reported as consistent. Positive confirmation of unprescribed medications or illicit substances will be reported as inconsistent and highlighted in red.
Note: Not all reports contain all of these elements.
7. History
Includes patient’s DRUGSCAN ® monitoring history for up to the last 5 DRUGSCAN ® tests.
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10. Test Methods • EIA Screening: (Enzyme Immunoassay)
8. Value Graph
Initial screening test using an antibodyantigen reaction to determine if a drug class is present in a sample. If a sample is negative for a drug class using EIA, then it is reported negative for that class and no further testing is conducted unless confirmation of negative is ordered. If it is positive, confirmation testing is performed by GC/MS or LC/MSMS. • GC/MS: GC/MS (Gas Chromatography with a Mass Spectrometry) This technique is used to separate drugs and metabolites (chromatography) and to uniquely identify them (mass spectrometry). This technique is considered the “gold standard” for detecting and quantifying drugs and their metabolites. • LC/MS/MS: LC/MS/MS Liquid Chromatography with Tandem Mass Spectrometry Technique used to separate drugs / metabolites while they are dissolved in a liquid. MS/MS, also called “tandem mass spectrometry” utilizes dual mass analyses of the drug / metabolite, which is more speci c than single MS. Drugs / Metabolites can be quantified at extremely low concentrations.
Graph of inconsistent result values for up to the last five reports.
9. Detailed Results • Test Name
Class & Specific Metabolites. • Test Result Positive or negative for class or metabolite. • Report Value Amount of drug or metabolite detected in ng/mL • Cut Off Level If 1 value appears, the number represents the confirmation level (LC/MS/MS or GC/MS) If 2 values appear, the 1st number represents the screen level (EIA), and the 2nd number represents the confirmation level (LC/MS/MS or GC/MS) or GC/MS). • Determination Will be reported as “Consistent” or “Inconsistent” with expected medication / drug list. • Note Notes that help further explain results will appear in this section of the report. If illicit drugs or prescribed medications are detected it will be noted here. This section will also provide an explanation of inconsistent results.
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11. Validity Testing • Speci c Gravity & Creatinine - A urine specimen is considered dilute when: speci c gravity falls between 1.0010 and 1.0030 and creatinine is less than 20 mg/d. This is a signal that the concentration of the urine is very weak. This can be caused by: Increased uid intake (intentional), or, presence of a serious disease state. Increased uid intake also reduces concentration of excreted material in urine. A decrease in the concentrated material may in uence the outcome of a drug test. Diuretics (such as Lasix) may also lower creatinine levels within six hours of ingestion.
Note: Not all reports contain all of these elements.
Note: Not all reports contain all of these elements.
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• Adulterants (Nitrites) - Specimens are considered adulterated when the pH is < 3.0 or > 11.0 or when Nitrite results are greater than 200. This occurs when a substance is added to a sample after collection to “mask” drug presence or “trick” the testing method. Common substances added are lime, vinegar, bleach, ammonia, lemon, Drano, salt, methanol, detergent, blood, gluteraldehyde (Urinaid or Clear Choice additives), or water. Many of the adulterants will leave a trace odor or alter the color of the urine. Some products added to a sample will increase the temperature of the sample, making it hot to touch and registering a temperature far above 100 F. Note: There are numerous products available that claim being added to a urine sample will “fool” the drug test and the individual will test negative. These products (nitrites , pyridium chlorochromate, or glu- teraldehydes) oxidize the sample so that con rmation by GC/MS is not possible. Therefore, the screening test will detect the drug concentration, however, when the sample is tested by GC/MS, the drug concentration present will not be con rmable. • pH measures acidity or alkalinity of the body. The normal Range is published as 3.0-11.0. An expected urine range for a healthy adult is 4.6 to 8.0. Neutral pH is considered to be 7.0 and in most body uids is maintained between 7.35 and 7.45. Urine pH may be affected by various factors, even after collection. • Uncovered container allows CO2 to escape or bacteria to enter the sample and increase pH. • Diet high in citrus fruits, vegetables or dairy products may increase urine pH. • Diet high in meat products or cranberries may decrease urine pH. • Medications like ammonium chloride, chlorothiazide diuretics and methenamine mandelate may increase urine pH. • Acetazolamide, potassium citrate, and sodium bicarbonate may decrease urine pH. • Some disease states may have an in uence on urinary pH (diabetes, renal failure and urinary tract infections). • Urine pH is generally measured to identify adulteration of the sample in an attempt to cause false the immunoassay results.
Copyright © 2020 DRUGSCAN Inc. Detailed Results on following page(s)...
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Toxicology Hotline: 888.370.1378
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Copyright © 2020 DRUGSCAN Inc. Detailed Results on following page(s)...
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Copyright © 2020 DRUGSCAN Inc.
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Toxicology Hotline: 888.370.1378
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The Buprenorphine and Norbuprenorphine Normalized graphs represent the concentration of buprenorphine and norbuprenorphine in urine normalized to 100 mg/dL of creatinine. The mean and standard deviation ranges represent all buprenorphine and norbuprenorphine results in the DRUGSCAN ® Database. This plotted data is to help with the evaluation of the patient. This data cannot be used to determine dosage, frequency of ingestion, or time of ingestion of the medication. This data is not diagnostic for any disease states.
Copyright © 2020 DRUGSCAN Inc.
Continued on Next Page
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Copyright © 2020 DRUGSCAN Inc.
End of Report
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Toxicology Hotline: 888.370.1378
Toxicology Hotline: 888.370.1378
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BILLING INFORMATION
Dear Patient,
It is our policy to bill and accept payment from Medicare, Medicaid, and any third party insurance carrier. You may receive a notification from your insurance called an Explanation of Benefits (EOB). This is not a bill from DRUGSCAN ® . It is an explanation of how our claim was processed. After our review of the EOB, you may receive a bill for any additional amounts owed or because of a denial of services. If we are not directly contracted with your insurance company, they may send payment for this service directly to you. This is not because of anything your physician or DRUGSCAN ® failed to do. Instead, your insurance company pays you directly so you can pay out of network providers. If you receive such a payment from your insurance company, please sign the check on the back and indicate “Pay to the order of DRUGSCAN ® , Inc.”. Please mail the check and any correspondence that accompanied the payment to the address below. In addition, they may have additional patient responsibility for any co-pay, co-insurance or deductible that your insurance EOB states. Please forward all payments to DRUGSCAN ® at PO Box 347, Horsham, PA 19044 If you require assistance with paying your bill, contact the billing customer service department to discuss payment plan options or the patient assistance program at 844.345.1821 or email patient.billing @ DRUGSCAN.com.
Dear Client,
It is DRUGSCAN ® ’s policy to bill and accept payment from Medicare, Medicaid, and any third-party insurance carrier. Your patients may receive notifications from their insurance companies called Explanation of Benefits (EOB). This is not a bill from DRUGSCAN ® . It is an explanation of how our claim was processed. After our review of the EOB, they may receive a bill for any additional amounts owed or because of a denial of service. See the attached letter explaining when your patients may be billed. If DRUGSCAN ® is not directly contracted with your patient’s insurance, the insurance company may send payment for our service directly to the patient. (See the attached letter sent to all patients who have an insurance that frequently pays the patients directly). If a patient receives such a payment from their insurance company, please have them sign the back of the check and indicate “Pay to the order of DRUGSCAN ® , Inc.”. The check can be mailed along with any correspondence that accompanied the payment to the address below. In addition, they may have additional patient responsibility for any co-pay, co-insurance or deductible that the insurance EOB states. This may be billed on the same or a separate statement. Patients can forward all payments to DRUGSCAN ® at PO Box 347 Horsham, PA 19044 If you your patient requires assistance with paying their bill, they can contact the billing customer service department to discuss payment plan options or the patient assistance program at 844.345.1821 or email patient.billing @ DRUGSCAN.com. Sincerely, Billing Customer Service Department 1.844.345.1821 Patient.billing @ DRUGSCAN.com
Sincerely, Billing Customer Service Department
PO Box 347, Horsham, PA 19044 | 844.345.1821 | patient.billing @ DRUGSCAN.com
PO Box 347, Horsham, PA 19044 | 844.345.1821 | patient.billing @ DRUGSCAN.com
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Letter sent to any patient that has an insurance plan that frequently pays the member.
Medicare Coverage Update
Date: 07/01/2020
Dear Client,
Last Name, First Name House number and street name City, State, Zip Code
Novitas Medicare revised their Limited Coverage Decision (LCD) for Qualitative and Quantitative Drug Testing, effective 10/01/2021. The full Controlled Substance Monitoring and Drugs of Abuse Testing Policy (A56645) can be found at: http://www.novitas-solutions.com/ & https://www.cms.gov/. Alternatively, DRUGSCAN can provide you with a copy of the Medicare LCD updated 10/01/2021. Should you have questions regarding this communication please contact the DRUGSCAN Billing Department at 844.345.1821. Please note that DRUGSCAN does not and cannot provide guidance or direction on our referring physicians’ internal billing or reimbursement practices. Only the physician can determine the specific diagnosis(es) code(s) that are applicable to a specific patient on a specific date of service, and DRUGSCAN must rely on the physician to provide the appropriate diagnosis(es) code(s). This diagnosis code reference guide is provided as an aid to physicians and office staff in determining when an ABN (Advance Beneficiary Notice) is necessary. Diagnosis codes must be applicable to the patient’s symptoms or conditions and must be consistent with documentation in the patient’s medical record. DRUGSCAN does not recommend any diagnosis codes and will only submit diagnosis information provided to us by the ordering physician or his/her designated staff. The CPT codes provided are based on AMA guidelines and are for informational purposes only. For informational and reference purposes only, attached are the most common ICD-10 codes submitted to DRUGSCAN.
Dear [Customer Name]
On 07/01/2020 your Physician requested laboratory testing performed by DRUGSCAN ® . We since submitted a claim to your insurance company, (“Name of Insurance”), for payment of this test. Because we are not directly contracted with this insurance company, they may send payment for this service directly to you. This is not because of anything your physician or DRUGSCAN ® failed to do. Instead, your insurance company pays you directly so you can pay out of network providers. We will continue to work with (“Name of Insurance”) to eliminate this confusing and inefficient practice of sending payments directly to patients like yourself (rather than to the provider, as most insurance companies do). We expect you may receive a check for several hundred dollars from your insurance company, along with an Explanation of Benefits (“EOB”) that describes certain lab testing performed on 05/01/2020. If you receive such a payment from your insurance company, please sign the check on the back and indicate “Pay to the order of DRUGSCAN ® , Inc.”. Please mail the check and any correspondence that accompanied the payment in the enclosed return envelope using the pre-addressed return page. In addition, you may have additional patient responsibility for any co- pay, co-insurance or deductible that your insurance EOB states. This may be billed back to you on a separate statement. If the information you receive from your insurance company does not include a payment, you do not need to do anything unless you receive a bill from DRUGSCAN ® , Inc. EOBs are not requests for payment, but information from your insurance company to you. We appreciate your assistance in this matter. If you have any questions or concerns please contact billing customer service at 1.844.345.1821 or at patient.billing @ DRUGSCAN.com.
Sincerely, DRUGSCAN ® , Inc.
Sincerely, Customer Service DRUGSCAN ® , Inc.
PO Box 347, Horsham, PA 19044 | 844.345.1821 | patient.billing @ DRUGSCAN.com
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Diagnosis Codes:
Coverage for Screens Yes/with secondary covered dx
Coverage for Confirms Yes/with secondary covered dx
Diagnosis Code
Coverage for Screens
Coverage for Confirms
Diagnosis Code
Diagnosis Description
Diagnosis Description
F11.90 OPIOID USE, UNSPECIFIED, UNCOMPLICATED
NO NO NO NO NO NO
YES YES YES YES YES YES
Z71.51 DRUG ABUSE COUNSELING AND SURVEILLANCE OF DRUG ABUSER
F11.11 OPIOID ABUSE, IN REMISSION
F16.10 HALLUCINOGEN ABUSE, UNCOMPLICATED
Z79.891 LONG TERM (CURRENT) USE OF OPIATE ANALGESIC F11.20 OPIOID DEPENDENCE, UNCOMPLICATED Z79.899 OTHER LONG TERM (CURRENT) DRUG THERAPY
YES YES YES YES YES YES YES YES YES YES YES YES YES
YES YES YES YES YES YES YES YES YES YES YES YES YES
F31.9
BIPOLAR DISORDER, UNSPECIFIED
F12.21 CANNABIS DEPENDENCE, IN REMISSION
F10.99 ALCOHOL USE, UNSPECIFIED WITH UNSPECIFIED ALCOHOL-INDUCED DISORDER
M54.50 LOW BACK PAIN, UNSPECIFIED
F15.99 OTHER STIMULANT USE, UNSPECIFIED WITH UNSPECIFIED STIMULANT-INDUCED DISORDER
NO
YES
M54.2 CERVICALGIA
M54.59 OTHER LOW BACK PAIN
F19.94 OTHER PSYCHOACTIVE SUBSTANCE USE, UNSPECIFIED WITH PSYCHOACTIVE SUBSTANCE-INDUCED MOOD DISORDER
NO
YES
F19.20 OTHER PSYCHOACTIVE SUBSTANCE DEPENDENCE, UNCOMPLICATED
M54.16 RADICULOPATHY, LUMBAR REGION
YES YES
NO NO
F20.9 F25.9
SCHIZOPHRENIA, UNSPECIFIED
M47.816 SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY, LUMBAR REGION M47.812 SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY, CERVICAL REGION M51.36 OTHER INTERVERTEBRAL DISC DEGENERATION, LUMBAR REGION
SCHIZOAFFECTIVE DISORDER, UNSPECIFIED
MAJOR DEPRESSIVE DISORDER, RECURRENT SEVERE WITHOUT PSYCHOTIC FEATURES
F33.2
NO
YES
YES YES YES YES YES YES
F34.1
DYSTHYMIC DISORDER
NO NO NO NO NO NO
M79.7 FIBROMYALGIA
F10.239 ALCOHOL DEPENDENCE WITH WITHDRAWAL, UNSPECIFIED F13.10 SEDATIVE, HYPNOTIC OR ANXIOLYTIC ABUSE, UNCOMPLICATED F15.90 OTHER STIMULANT USE, UNSPECIFIED, UNCOMPLICATED F16.20 HALLUCINOGEN DEPENDENCE, UNCOMPLICATED F19.10 OTHER PSYCHOACTIVE SUBSTANCE ABUSE, UNCOMPLICATED
M54.17 RADICULOPATHY, LUMBOSACRAL REGION
YES
YES
M47.817 SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY, LUMBOSACRAL REGION
M51.16 INTERVERTEBRAL DISC DISORDERS WITH RADICULOPATHY, LUMBAR REGION
YES YES YES YES YES YES YES YES YES YES YES YES
YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES
F20.0
PARANOID SCHIZOPHRENIA
M51.37 OTHER INTERVERTEBRAL DISC DEGENERATION, LUMBOSACRAL REGION
BIPOLAR DISORDER, CURRENT EPISODE DEPRESSED, SEVERE, WITH PSYCHOTIC FEATURES MAJOR DEPRESSIVE DISORDER, RECURRENT, MILD MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED
F31.5
NO
YES
M79.2 NEURALGIA AND NEURITIS, UNSPECIFIED M54.51 VERTEBROGENIC LOW BACK PAIN
YES YES YES YES YES YES
F33.0 F33.9
NO NO NO NO NO NO
M25.50 PAIN IN UNSPECIFIED JOINT
M54.10 RADICULOPATHY, SITE UNSPECIFIED
F43.22 ADJUSTMENT DISORDER WITH ANXIETY
M79.18 MYALGIA, OTHER SITE
F11.220 OPIOID DEPENDENCE WITH INTOXICATION, UNCOMPLICATED
G40.909 EPILEPSY, UNSPECIFIED, NOT INTRACTABLE, WITHOUT STATUS EPILEPTICUS
F13.90 SEDATIVE, HYPNOTIC, OR ANXIOLYTIC USE, UNSPECIFIED, UNCOMPLICATED
M54.14 RADICULOPATHY, THORACIC REGION
F25.1
SCHIZOAFFECTIVE DISORDER, DEPRESSIVE TYPE
M54.18 RADICULOPATHY, SACRAL AND SACROCOCCYGEAL REGION M79.12 MYALGIA OF AUXILIARY MUSCLES, HEAD AND NECK F10.20 ALCOHOL DEPENDENCE, UNCOMPLICATED F15.20 OTHER STIMULANT DEPENDENCE, UNCOMPLICATED
F31.12 BIPOLAR DISORDER, CURRENT EPISODE MANIC WITHOUT PSYCHOTIC FEATURES, MODERATE F31.60 BIPOLAR DISORDER, CURRENT EPISODE MIXED, UNSPECIFIED
NO
YES
YES YES YES YES YES YES
NO NO NO NO NO NO
NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO
F43.12 POST-TRAUMATIC STRESS DISORDER, CHRONIC
F11.99 OPIOID USE, UNSPECIFIED WITH UNSPECIFIED OPIOID-INDUCED DISORDER
F12.20 DORSALGIA, UNSPECIFIED
F14.90 COCAINE USE, UNSPECIFIED, UNCOMPLICATED F15.11 OTHER STIMULANT ABUSE, IN REMISSION F19.11 OTHER PSYCHOACTIVE SUBSTANCE ABUSE, IN REMISSION
F14.20 COCAINE DEPENDENCE, UNCOMPLICATED F43.10 POST-TRAUMATIC STRESS DISORDER, UNSPECIFIED
F14.10 COCAINE ABUSE, UNCOMPLICATED
F13.20 SEDATIVE, HYPNOTIC OR ANXIOLYTIC DEPENDENCE, UNCOMPLICATED
F31.30 BIPOLAR DISORDER, CURRENT EPISODE DEPRESSED, MILD OR MODERATE SEVERITY, UNSPECIFIED
NO
YES
F10.21 ALCOHOL DEPENDENCE, IN REMISSION F11.21 OPIOID DEPENDENCE, IN REMISSION F15.21 OTHER STIMULANT DEPENDENCE, IN REMISSION
BIPOLAR DISORDER, CURRENT EPISODE DEPRESSED, SEVERE, WITHOUT PSYCHOTIC FEATURES
F31.4
NO
YES
YES YES
F31.77 BIPOLAR DISORDER, IN PARTIAL REMISSION, MOST RECENT EPISODE MIXED
NO NO
F60.3 F32.9
BORDERLINE PERSONALITY DISORDER
F31.89 OTHER BIPOLAR DISORDER
MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED
MAJOR DEPRESSIVE DISORDER, RECURRENT, SEVERE WITH PSYCHOTIC SYMPTOMS
F33.3
NO
YES
F15.10 OTHER STIMULANT ABUSE, UNCOMPLICATED F12.90 CANNABIS USE, UNSPECIFIED, UNCOMPLICATED
YES YES YES YES YES
F33.40 MAJOR DEPRESSIVE DISORDER, RECURRENT, IN REMISSION, UNSPECIFIED F33.41 MAJOR DEPRESSIVE DISORDER, RECURRENT, IN PARTIAL REMISSION F33.42 MAJOR DEPRESSIVE DISORDER, RECURRENT, IN FULL REMISSION
NO NO NO NO NO
F10.11 ALCOHOL ABUSE, IN REMISSION
F19.99 OTHER PSYCHOACTIVE SUBSTANCE USE, UNSPECIFIED WITH UNSPECIFIED PSYCHOACTIVE SUBSTANCE-INDUCED DISORDER
F45.1 F60.9
UNDIFFERENTIATED SOMATOFORM DISORDER PERSONALITY DISORDER, UNSPECIFIED
F32.1 F33.1 F25.0
MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, MODERATE MAJOR DEPRESSIVE DISORDER, RECURRENT, MODERATE
LOCALIZATION-RELATED (FOCAL) (PARTIAL) IDIOPATHIC EPILEPSY AND EPILEPTIC SYNDROMES WITH SEIZURES OF LOCALIZED ONSET, NOT INTRACTABLE, WITHOUT STATUS EPILEPTICUS
SCHIZOAFFECTIVE DISORDER, BIPOLAR TYPE
G40.009
NO
YES
F31.81 BIPOLAR II DISORDER
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Missing Information and Required Fields The following information is required from the client when sending a specimen for testing. If this data is not supplied, a missing information report will be sent by fax or email to a designated contact person. The report is generated each Tuesday and will be sent to the designated contact person on a weekly basis until the required information is supplied. We ask that you please return any missing information to the billing fax #1.888.972.1105 prior to the following Tuesday or it will result in the same information being requested on the next week’s report. Note: See example missing information report and error codes included in binder DEFINITION Unknown Payor/Insurance Information If no insurance information was provided with the requisition and self pay is not noted, it will result in a request for the information. **Copy of the insurance card suggested.** MISSING INFO ERROR
Missing Information Report Common Error Codes and Explanation
DESCRIPTION
ERROR CODE
LCNOABN
Patient has a Medicare Advantage/Replacement or Medicare Plan which requires a medically necessary diagnosis code for Qualitative/Quantitative testing. Please see the Common ICD-10 Codes submitted to DRUGSCAN ® attachment for further details. If the patient has a Worker’s Comp or no-fault claim the Date of Injury/Accident is required for the claim to be processed properly. The insurance information provided to DRUGSCAN ® for this date of service is not valid or active. Please provide updated Insurance Information for the patient or mark as self-pay. The specimen was received by DRUGSCAN ® without insurance information provided or additonal information is needed to determine the insurance carrier. Please provide the insurance carrier/member ID number. The patient’s address was not provided on the face sheet. This information is required to submit our claim to the specified insurance/WC/ MVA carrier. The diagnosis code provide is missing digits/ incomplete. This information is required to submit our claim to the specified insurance/WC/ MVA carrier. The diagnosis code provided is invalid. Please check the code and provide a valid diagnosis code. The specimen was received by DRUGSCAN ® without a diagnosis code provided on the requisition form or face sheet. This information is required to submit our claim to the specified insurance/WC/ MVA carrier. The diagnosis code provided is not an ICD-10 acceptable code. Please review the code and provide a valid ICD-10 code. The insurance/WC/MVA member ID number or claim number is invalid or missing. We received the patient’s Worker’s Comp/MVA carrier information but the claim number is missing or invalid.
ONSETDATE
INELIGIBLE
Insurance ID/Subscriber ID
The insurance/subscriber ID of the patient’s insurance. This can be alpha numeric.
UNKPYR
Date of Birth
The date of birth of the patient.
Patient Address
The current address of the patient. Please keep updated for accuracy.
PTADD1
Medicare Patients
Patients that have a Medicare Plan: Provide a valid member ID number and complete spelling of the patient’s name including any suffix(Jr, Sr, III…) as listed on the Medicare card. If the patient has a Medicare replacement plan please provide insurance name & ID number. **Copy of the Insurance Card suggested** Patients that have a Medicaid Plan: Provide a valid member ID number. If the patient has a Medicaid replacement plan please provide insurance name & ID number. **Copy of the Insurance Card suggested** Patients that have a worker comp or no-fault (MVA) claim should provide the complete carrier name, address, phone number, valid claim number & date of injury/date of accident. For Worker’s Compensation claims, date of injury or date of accident for Motor Vehicle accidents is necessary for billing. This code is a classification describing the diagnosis from the physician determining the medical necessity for testing. This should always be to the highest specificity, when applicable. We require the diagnosis code be provided for each date of service, and the report needs to be signed for the code to be valid. Medicare requires a specific diagnosis code for the testing to be deemed as medically necessary. Please see the Medicare Coverage update for the list of covered codes for screens and confirms included in this binder and attached to every missing information report.
DXLVL*
Medicaid Patients
NOVALIDDIAG*
NODIAG*
Work Comp/ No-Fault Claim
DIAGTABLE*
Date of Injury/Date of Accident
SUBID
ICD-10 Diagnosis Code
CLAIM #
LCNOABN
* The signature of the office employee providing any diagnosis code information is required on the report. ** Reports are generated on a weekly basis and requested information will be faxed or emailed directly to the client
For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
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Insurance Submission and Required Fields Insurances change often so it is very important to send accurate insurance and demographic information with every requisition. This will prevent additional inquiries or possible patient bills that could result if your patient is no longer eligible with the insurance previously submitted. Third Party Insurances require necessary data to properly adjudicate claims submitted on behalf of your patients. Below are the required fields for most insurances. If this data is not being supplied, a missing information report will be created and sent back to your office asking for the information. We please ask that you return all requested missing information back within a week of the request. (See the missing information section included in binder).
DATA FIELD
DEFINITION
Patient Name
Proper spelling of first and last name of patient that appears on their insurance card.
Subscriber Name/DOB
Name & birthdate of person who is the primary holder of the insurance. Usually this is the patient but could be a spouse or parent/guardian. The name of the primary insurance carrier of the patient. If patient also has secondary insurance information, please provide as well with all fields included in this table. (Specify who is primary & secondary).
Primary Insurance Name (Payer)
Insurance ID number
The insurance id of the patient’s insurance. This can be made up of alphas and numbers.
ICD-10 Diagnosis Code
This code is a classification describing the diagnosis from the physician determining the medical necessity for testing. This should always be to the highest specificity, when applicable, as well as meeting limited coverage determinations. (See Medicare coverage update).
Date of Birth
The date of birth of the patient.
Gender
The sex of the patient.
Relationship
Self, spouse or dependent.
Patient Address
The current address of the patient. This should always be updated for accuracy.
Ordering Physician
The physician that is ordering the testing. It is necessary that the ordering physician is PECOS enrolled when submitting Medicare claims. Please refer to CMS website for information. It is also necessary that the ordering physician is State Medicaid enrolled when submitting Medicaid claims. Please refer to State Medicaid website for information. For Worker’s Comp claims, date of injury or date of accident for motor vehicle accidents is necessary for billing.
Date of Injury/Date of Accident
Note: If patient is uninsured and should be billed at DRUGSCAN ® ’s self pay rate, please clearly write “SELF PAY” on the requisition and face sheet. For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
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When Will Your Patients Receive a Bill From DRUGSCAN®?
Excessive Testing Policies The following insurances have excessive testing policies regarding Presumptive and Definitive Drug testing where services will not be reimbursed if thresholds are met. Please take note of these policies to assist in your patient’s treatment and service.
SITUATION
DEFINITION
Self pay/Uninsured
If a patient is uninsured, DRUGSCAN ® will bill at our current self pay rate.
INSURANCE PAYER
PROCEDURE
POLICY
Aetna
Presumptive and Definitive Drug Testing
The frequency limit for each (presumptive and definitive) is 8 times per 365 days, from the time of service is first rendered.
Drug testing is not a covered benefit under the patient’s plan.
DRUGSCAN ® will bill at our current self pay rate.
Presumptive screening up to 24 times per year, beginning at the start of treatment, as part of a routine monitoring program. Definitive urine drug testing is considered medically necessary when all the following criteria are met: The presumptive urine drug testing was done for a medically necessary reason; and The presumptive test was negative for prescribed medications, positive for a prescription drug with abuse potential which was not prescribed, or positive for an illegal drug (for example, but not limited to methamphetamine or cocaine), and; The specific definitive test(s) ordered are supported by documentation specifying the rationale for each quantitative test ordered; and Clinical documentation reflects how the results of the test(s) will be used to guide clinical care.
Amerigroup of IA
Presumptive and Definitive
DRUGSCAN ® is contracted with the patient’s insurance plan.
DRUGSCAN ® will bill per the EOB (explanation of benefits).
Drug Testing
Patient lives outside of NY, FL, CO, ID, SD and does not have Harvard Pilgrim: DRUGSCAN ® will bill at our reduced out of network rate, if applicable. Patient lives in NY, FL, CO, ID, SD or has Harvard Pilgrim: DRUGSCAN ® will bill per the EOB, if applicable as required by state law or plan requirements. Patient lives outside of NY, FL, CO, ID, SD: DRUGSCAN ® will bill the total amount of the insurance check plus any patient responsibility but at our reduced out of network rate, if applicable. Patient lives in NY, FL, CO, ID, SD: DRUGSCAN ® will bill the total amount of the insurance check plus any patient responsibility applied per the EOB, if applicable as required by state law or plan requirements. Note: If the insurance check or balance of the insurance check is not sent to DRUGSCAN ® by the patient, further collection efforts may be taken.
DRUGSCAN ® is not contracted with the patient’s commercial insurance plan and has not received a check for our services.
DRUGSCAN ® is not contracted with the patient’s commercial insurance plan and patient has received a check for DRUGSCAN ® ’s services.
BCBS of NC
Definitive Drug Testing
G0480 (1 – 7 drug classes) is the only covered panel code. G0481 and up is not covered.
Patient has a Medicare/ Medicaid Managed care plan and a Copay/Deductible/Co- insurance is applied.
DRUGSCAN ® will bill per the EOB (explanation of benefits).
DRUGSCAN ® will bill at our current self pay rate.
Insurance provided by client is termed/ineligible
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For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
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BCBS of IA/Wellmark of IA
The frequency of drug testing should be individualized to the treatment plan. Frequency shall not exceed every 7 days at any time during the treatment process.
Caresource of Ohio
Presumptive and Definitive Drug Testing
CareSource will reimburse for up to 5 presumptive/confirmatory tests in a quarter for each member.
In outpatient pain management, and outpatient substance abuse
Cigna
Presumptive Drug Testing
Presumptive drug testing not to exceed one 1 unit per date of service up to 32 units per year as medically necessary.
settings qualitative/presumptive (ie, immunoassay) urine drug testing may be considered medically necessary for: Baseline screening before initiating treatment or at the time treatment is initiated, one time per program entry stabilization phase - targeted weekly qualitative screening for a maximum of four weeks maintenance phase – targeted qualitative screening once every one to three months quantitative/ definitive (ie, confirmatory) urine drug testing may be considered medically necessary under the following circumstances: When immunoassays for the relevant drug(s) are not commercially available Only in specific situations for which definitive/quantitative drug levels are required for clinical decision making. Urine drug testing for patients receiving pain medication are considered medically necessary under the following conditions: • Twice a year for patients who are low or moderate risk • Four times a year for patients who are high risk At the time of the office visit for patients demonstrating aberrant behavior defined by one or more of the following: • Lost prescriptions • Requests for early refills • Obtained opioids from multiple providers • Unauthorized dose escalation • Apparent intoxication.
Definitive Drug Testing
Definitive drug testing not to exceed 16 dates of service per year for a maximum of 8 units (a unit may include a specific individual drug and/or its metabolite(s), or its structural isomer(s)) per date of service up to 128 units per year as medically necessary. Qualitative drug screen when billed with any combination of more than twenty (20) units within 365 days per Member.
Fallon Health
Presumptive Drug Testing
Humana (All Plans)
Definitive Drug Testing # HCS- 0532-015
Coverage of drug testing is limited to seven or fewer drug classes per day. G0481 and up is not covered.
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For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
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