How To Use CPT Code 80364

CPT 80364 describes the measurement or detection of five or more opioids and opiate analogs in a patient specimen. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 80364?

CPT 80364 can be used to measure or detect the presence of five or more opioids and opiate analogs in a patient specimen. This code is used when a lab analyst performs a test using methodologies such as gas chromatography or mass spectrometry to identify and quantify these substances in the specimen.

2. Official Description

The official description of CPT code 80364 is: ‘Opioids and Opiate analogs; 5 or more.’

3. Procedure

1. The lab analyst collects a patient specimen, such as urine or blood.
2. The specimen is subjected to a test using methodologies like gas chromatography or mass spectrometry.
3. The test separates and analyzes the opioids and opiate analogs present in the specimen.
4. The lab analyst quantitates the analyte, measuring the exact amount of the substances detected.
5. The test may be quantitative, qualitative (positive or negative result), or a combination of both.

4. Qualifying circumstances

CPT 80364 is ordered by clinicians to determine whether a patient has taken an overdose of five or more opioids or analogs or to assess compliance with a prescribed regimen. It is not limited to testing for a specific condition and can be used in various clinical scenarios.

5. When to use CPT code 80364

CPT code 80364 should be used when a lab analyst performs a test to measure or detect the presence of five or more opioids and opiate analogs in a patient specimen. It is important to ensure that the test specifically targets these substances and not a different number of opioids or analogs.

6. Documentation requirements

To support a claim for CPT 80364, the documentation should include:

• Reason for ordering the test, such as suspected overdose or compliance monitoring
• Type of specimen collected (urine, blood, etc.)
• Methodology used for testing (gas chromatography, mass spectrometry, etc.)
• Results of the test, including the presence or absence of five or more opioids and opiate analogs
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 80364, ensure that the test is performed by a lab analyst and that it specifically measures or detects five or more opioids and opiate analogs. It is important to follow any additional guidelines provided by payers regarding the reporting of this code. Consider reporting separate codes for specimen collection if required by the payer.

8. Historical information

CPT 80364 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst measures the presence of five or more opioids and opiate analogs in a urine specimen to determine if a patient has overdosed on these substances.
2. A clinician orders a test to detect the presence of five or more opioids and opiate analogs in a blood specimen to assess a patient’s compliance with a prescribed regimen.
3. A lab analyst performs a test using gas chromatography to measure the amount of five or more opioids and opiate analogs in a urine specimen to aid in the diagnosis of substance abuse.
4. A patient presents with symptoms of opioid overdose, and a lab analyst tests their urine specimen for the presence of five or more opioids and opiate analogs to confirm the diagnosis.
5. A clinician suspects that a patient is not adhering to their prescribed opioid regimen and orders a test to detect the presence of five or more opioids and opiate analogs in a urine specimen.
6. A lab analyst uses mass spectrometry to measure the amount of five or more opioids and opiate analogs in a blood specimen to monitor a patient’s response to opioid therapy.
7. A patient with a history of substance abuse undergoes a test to detect the presence of five or more opioids and opiate analogs in their urine specimen as part of a treatment program.
8. A clinician orders a test to measure the amount of five or more opioids and opiate analogs in a blood specimen to assess a patient’s tolerance to opioid medications.
9. A lab analyst performs a test using gas chromatography to detect the presence of five or more opioids and opiate analogs in a urine specimen to assist in the management of chronic pain.
10. A patient presents with symptoms of opioid withdrawal, and a lab analyst tests their urine specimen for the presence of five or more opioids and opiate analogs to guide treatment decisions.