Maternal Or Neonatal Hair
Hair, both maternal and neonatal, is another useful tissue for drug screening. It has advantages as a screening tissue because it is easy to collect and has a long window of detection up to months depending on the length of the hair . Neonatal hair begins to protrude from the scalp around the beginning of the third trimester, and therefore may provide insight into third trimester drug use . Some drawbacks of hair as a screening tissue include: differential drug deposit in hair depending on hair type , environmental contamination , limited amount of neonatal hair or social or cultural objection to removal of hair and bald babies. Extensive sample extraction and manipulation is also required and certain drugs may extract poorly from hair .
Collectively, hair as a matrix has utility when trying to determine long-term drug use. Hair is also a valuable matrix when a sample is required immediately, to aid in diagnosis of the neonate, and when it would not be practical to wait for meconium.
Cpt Codes Not Covered For Indications Listed In The Cpb:
0051U Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, urine, 31 drug panel, reported as quantitative results, detected or not detected, per date of service 0078U Pain management genotyping panel, 16 common variants , buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid-use disorder 0082U Drug test, definitive, 90 or more drugs or substances, definitive chromatography with mass spectrometry, and presumptive, any number of drug classes, by instrument chemistry analyzer , urine, report of presence or absence of each drug, drug metabolite or substance with description and severity of significant interactions per date of service 0093U Prescription drug monitoring, evaluation of 65 common drugs by LC-MS/MS, urine, each drug reported detected or not detected 0143U – 0150U Drug assay, definitive, urine, quantitative liquid chromatography with tandem mass spectrometry using multiple reaction monitoring , with drug or metabolite description, comments including sample validation, per date of service 0227U Drug assay, presumptive, 30 or more drugs or metabolites, urine, liquid chromatography with tandem mass spectrometry using multiple reaction monitoring , with drug or metabolite description, includes sample validation
Benefits Of Urine Testing
Parent Drug and Metabolite Detection
Urinalysis can detect high concentrations of parent drugs andtheir metabolites. Metabolite detection helps eliminate confusion over which substances have been consumed, cutting the risk of adverse drug-to-drug interactions.
Generous Detection Window
You get a view of substances that have passed through a patients system for up to six days, depending on the substance.
Urine drug testing can be conducted in a variety of ways to provide the information you needinstant results and full lab-based testing can all provide an in-depth look at recent drug use. Additionally, tests are available when adulteration is a concern.
Speed and Simplicity
Samples are collected without putting undue stress on patients or medical staff, and the test provides quick results. Quantitative results can be seen in as little as 48 hours.
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Beaker Location Container And Temperature
BW TOXICOLOGY: URINE CUP R -RefrigeratedBW TOXICOLOGY: 10 ML URINE YELLOW TUBE -RefrigeratedBW TOXICOLOGY: UR YELLOW/GREY -RefrigeratedBL CHEMISTRY: URINE CUP R -RefrigeratedBL CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedBL CHEMISTRY: UR YELLOW/GREY -RefrigeratedBR CHEMISTRY: URINE CUP R -RefrigeratedBR CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedBR CHEMISTRY: UR YELLOW/GREY -RefrigeratedGM CHEMISTRY: URINE CUP R -RefrigeratedGM CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedGM CHEMISTRY: UR YELLOW/GREY -RefrigeratedKL CHEMISTRY: URINE CUP R -RefrigeratedKL CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedKL CHEMISTRY: UR YELLOW/GREY -RefrigeratedLH CHEMISTRY: URINE CUP R -RefrigeratedLH CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedLH CHEMISTRY: UR YELLOW/GREY -RefrigeratedPH CHEMISTRY: URINE CUP R -RefrigeratedPH CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedPH CHEMISTRY: UR YELLOW/GREY -RefrigeratedRC CHEMISTRY: URINE CUP R -RefrigeratedRC CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedRC CHEMISTRY: UR YELLOW/GREY -RefrigeratedUN CHEMISTRY: URINE CUP R -RefrigeratedUN CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedUN CHEMISTRY: UR YELLOW/GREY -RefrigeratedZH CHEMISTRY: URINE CUP R -RefrigeratedZH CHEMISTRY: 10 ML URINE YELLOW TUBE -RefrigeratedZH CHEMISTRY: UR YELLOW/GREY -Refrigerated
Ethical Legal And Social Considerations In Screening
An additional concept is respect for autonomy a guiding principle in clinical ethics. Respect for autonomy means that the clinician must create an environment in which the patient is empowered to make informed decisions . This is not the same as beneficence where the clinician performs actions to the benefit of the patient. In the context of drug use in pregnancy, most literature surrounding respect for autonomy relates to women with chronic diseases such as schizophrenia or epilepsy that subsequently become pregnant. One relevant and very recent paper has examined pregnancy in the context of increasing cannabis decriminalization/legalization and respect for autonomy in these women . The authors report that although most women cut back or stop cannabis use in pregnancy, health care providers are relatively poor at counseling women and providing accurate clinical and scientific information to these patients. In part this is due to a lack of good information available from both scientific and clinical realms an issue we have alluded to above, but the authors also identify a need to avoid a punitive atmosphere, including that risks to the fetus and mother should neither be minimized, nor overstated.
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General Discussion And Conclusion
Until recently the general focus on drug risks in pregnancy has been solely toward the fetus, e.g., malformations, developmental delay or, complications of pregnancy such as pre-term birth and intra-uterine growth restriction. Partly because of this, we lack good understanding of the pharmacokinetics of drugs in pregnancy and the role of the maternal-placental-fetal unit, their ability to clear and eliminate substances and/or preferentially concentrate them toward the developing child, and the subsequent consequences of these dynamics.
Despite a clear need for tests, as evidenced by the current opioid epidemic our lack of pharmacological knowledge has been compounded by a general misunderstanding of addiction and substance use/misuse within the medical profession that is further complicated with respect to pregnant women and children. Misunderstanding is based on a lack of addiction knowledge in primary healthcare providers as well as a lack of evidence-based knowledge of drugs in pregnancy and the neonate. Moreover, local, state and federal policies tend to focus on the risks of illicit drugs, while ignoring the real need for medication and medical care for pregnant women, such as for medical pain at the end of pregnancy due to physiological stress . And then, in a punitive legal atmosphere drug use and misuse cannot be treated as a medical issue and becomes increasingly politicized, legalized and stigmatized in these pregnant women and for their children.
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Presumptive Drug Testing: Rapid Results For Your Patient
Presumptive drug testing can give you rapid results that can be used to help improve patient care. But whether a presumptive test is right for your patient depends on many factors, according to Dr Leland McClure, Director, Medical Science Liaison, Medical Affairs at Quest Diagnostics, and understanding the complexities of presumptive testing is vital for making the right testing choice. Dr McClure outlined these complexities in a recent webinar.
A presumptive test is a qualitative test used to detect the possible presence of a drug or drug class, he explained, based on the definition issued by the American Medical Association in 2015. Definitive testing is a qualitative or quantitative procedure that identifies the specific drugs and associated metabolites. Definitive testing typically follows presumptive testing, or may be the test of first choice.
CPT codes for presumptive testing1
CPT code: 80305 Drug test, presumptive, any number of drug classes, qualitative any number of devices or procedures, capable of being read by direct optical observation only includes sample validation when performed, per date of service .
CPT code: 80306 Drug test, presumptive, any number of drug classes, qualitative any number of devices or procedures, read by instrumented assisted direct optical observation includes sample validation when performed, per date of service .
Most presumptive drug tests at Quest Diagnostics will fit the CPT code 80307.
Content in Year
Scientific Approaches To Screening
Over the last several decades, there have been great advances in the tools available for drug screening and tests are now capable of giving more accurate and precise results than ever before. Traditionally, drug testing has been performed using ELISAs . This method has advantages in that it is relatively cheap, easy to perform in a general laboratory, and has a rapid turnaround time. Additionally, because ELISA has been used for many years, there are multiple commercial antibodies available that are validated in many human tissues. The reliability of an ELISA depends on the tissue being tested and the drugs being detected in that tissue. For certain tests, including cocaine metabolites in urine, ELISA is a reliable method . However, for other drug and tissue combinations there is a relatively high incidence of both false positives and negatives . A positive ELISA in maternal tissue should be flagged for further screening, and presence of the drug confirmed by a more specific test.
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The Cordant Difference: Going Above And Beyond What Other Laboratories Offer
- Extensive Drug Testing Menu with 180+ Metabolites and Parent Drugs
- 60+ Mental Health Testing Options in Urine and Oral Fluid
- 100x Lower Cutoff Buprenorphine Testing in Urine and Oral Fluid
- Powerful, Proprietary Technology that Combines Lab Test Ordering and Test Results with Detailed Trend Reports
- CLIA, CAP and CAP FDT Certified
- 1 of 2 companies outside of California to obtain a California License for Methadone Testing
In this short video, Richard Stripp, Ph.D., Cordants Chief Scientific and Technical Officer, explains the different drug testing options available including urine testing, saliva testing, hair testing and blood testing. Cordant Health Solutions offers all four options.
Cpt Codes Covered If Selection Criteria Are Met:
0007U Drug test, presumptive, with definitive confirmation of positive results, any number of drug classes, urine, includes specimen verification including DNA authentication in comparison to buccal DNA, per date of service 0011U Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites 0054U Prescription drug monitoring, 14 or more classes of drugs and substances, definitive tandem mass spectrometry with chromatography, capillary blood, quantitative report with therapeutic and toxic ranges, including steady-state range for the prescribed dose when detected, per date of service 80305 Drug test, presumptive, any number of drug classes, any number of devices or procedures capable of being read by direct optical observation only , includes sample validation when performed, per date of service 80306 Drug test, presumptive, any number of drug classes, any number of devices or procedures read by instrument assisted direct optical observation , includes sample validation when performed, per date of service 80307 Drug test, presumptive, any number of drug classes, any number of devices or procedures by instrument chemistry analyzers , chromatography , and mass spectrometry either with or without chromatography, includes sample validation when performed, per date of service 80376
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Coding Presumptive Drug Testing
Presumptive drug testing services may be performed prior to definitive drug screen testing , when a provider wants to rule out illicit drug uses or to confirm the presence of a particular drug class without identifying individual drugs or, to distinguish between structural isomers. For example, a patient using prescription opioids for pain management may receive a randomized drug screen service to test for the presence of opioids and illicit drugs, or other prescription drugs that may cause risk when combined with opioids .
Presumptive Drug Testing CPT Codes
Medicare and private payers require the same codes to report presumptive drug testing:
80305 Drug test, presumptive, any number of drug classes, any number of devices or procedures capable of being read by direct optical observation only includes sample validation when performed, per date of service 80306 Drug test, presumptive, any number of drug classes, any number of devices or procedures read by instrument assisted direct optical observation only includes sample validation when performed, per date of service 80307 Drug test, presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers , chromatography , and mass spectrometry either with or without chromatography, includes sample validation when performed per date of service
Definitive Drug Testing
Hcpcs Codes Covered If Selection Criteria Are Met:
G0480 Drug test, definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers , including, but not limited to GC/MS and LC/MS and enzymatic methods ) qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class, including metabolite if performed G0481 qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class, including metabolite if performed G0482 qualitative or quantitative, all sources, includes specimen validity testing, per day 15-21 drug class, including metabolite if performed G0659 Drug test, definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers , including but not limited to GC/MS and LC/MS , excluding immunoassays and enzymatic methods , performed in a single machine run without drug or class specific calibrations qualitative or quantitative, all sources, includes specimen validity testing, per day G2074 Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed
Prediction Of Opioid Misuse In Individuals Receiving Opioid Therapy For Cancer Pain
The authors stated that one of the drawbacks of this trial was that these investigators were unable to evaluate opioid use following the supportive care clinic consultation or to obtain real data on non-medical opioid use, such as urine drug screening . These researchers stated that further studies are needed, because this information will be very valuable in understanding how much aberrant opioid use behaviors will influence treatment and response in real practice.
The authors stated that one drawback of this trial was its retrospective design. Furthermore, the study was carried out among patients with cancer who had a relatively high level of symptom burden and distress and a potentially higher level of NMOU thus, these findings may not be generally applicable to other cancer patient populations receiving opioid therapy. Lastly, a normal UDT result does not always rule out NMOU. One of the most common forms of NMOU is taking prescribed opioids more frequently than directed. Unfortunately, such behavior could not be detected by UDT therefore, such patients may have normal UDT but still be using the opioid in an excessive or maladaptive manner. It was possible that the frequency of NMOU was higher than what the authors found in this trial. The therapeutic decision-making process surrounding opioid therapy should not be based solely on UDT, and more research is needed.
Maternal Or Fetal Blood
Blood is one of the most commonly collected tissues, but has limited use as a drug screening tool in pregnancy, and otherwise. It may not provide insight into maternal substance use if the woman has ceased drug use prior to medical appointments when blood will be drawn . In contrast, fetal blood is usually only taken from the umbilical cord after birth, as venous collection is difficult and invasive requiring a trained professional and only generally used in the case of a very select set of fetal abnormalities . However, both maternal and cord blood have a very short window of detection, and are rarely used clinically or in research for drug detection .
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Hcpcs Codes Not Covered For Indications Listed In The Cpb:
G0483 Drug test, definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers , including, but not limited to GC/MS and LC/MS and enzymatic methods ) qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class, including metabolite if performed
Types Of Screening For Illicit Drugs In Pregnant Women
There are a wide range of tissues available for screening drug use in pregnancy, each with their own advantages and disadvantages. Maternal tissues including blood, urine and hair can be screened before or after birth, and fetal tissues such as blood, urine, hair, and meconium can be screened following birth. Additionally, reproductive tissues such as the placenta and umbilical cord present potential screening matrices. Different matrices may provide insight into drug use at various times throughout pregnancy. So, in addition to choosing an acceptable tissue for screening, there are a number of different testing methods that can be used. Here, we will discuss screening methods by sample type, and highlight the advantages and disadvantages of each.
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