Z87.891 — Personal history of nicotine dependence
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the urine drug test was performed.
- For diagnostic urine drug tests, report the test result if known; if the result is not known, report the symptoms that prompted the performance of the test.
- This billing and coding guidance complements Local Coverage Determination L35724 and providers should follow LCD L35724 in conjunction with NCCI/OPPS rules when preparing claims.
Key Coverage Criteria
- When a referring/ordering physician is required by the service or LCD, the test is covered if the ordering/referring physician is documented and the order meets the Local Coverage Determination criteria.
- Urine drug testing performed as a diagnostic test or for clinical monitoring when there is a documented medical indication and a valid ICD-10-CM diagnosis code that best describes the patient's condition.
- Presumptive (qualitative/IA) urine drug testing is covered when medically necessary to immediately determine the presence or absence of drugs or drug classes to inform immediate clinical management.
- Point-of-care testing (POCT) is covered when medically necessary and the clinician caring for the beneficiary and the beneficiary are in the same location and immediate results are required for patient management.
- Definitive (quantitative/confirmation) UDT (e.g., GC-MS or LC-MS/MS) is covered when clinically indicated and medically necessary to identify specific medications, illicit substances, or metabolites not adequately detected by presumptive testing, to confirm or refute inconsistent presumptive results, to identify substances (e.g., fentanyl, meperidine, synthetic cannabinoids, designer drugs) missed by IA, or when definitive concentration data are necessary to guide management.
- In emergency or urgent care settings, presumptive UDT should be performed as part of evaluation for patients presenting with any of: coma, altered mental status without a defined toxidrome, severe or unexplained cardiovascular instability/cardiotoxicity, unexplained metabolic or respiratory acidosis, seizures of undetermined history, or when administration of a specific antagonist is considered.
6 Active Policies
A59416 — Billing and Coding: Urine Drug Testing
J06
L39611 — Urine Drug Testing
J06
AETNA-CPB-0380 — Lung Cancer Screening
AETNA-CPB-0702 — Abdominal Aortic Aneurysm Screening
A54799 — Billing and Coding: Urine Drug Testing
Related Codes
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