The Health Plan (THP) works hard to responsibly manage available health resources while promoting best practices and adherence to governmental regulation.
THP has approved point of care testing with oral fluids billed as 80305. THP recommends random point of care screening for illicit or inappropriate substance use for programs providing outpatient pain management and substance use disorder services, using either oral fluids or urine. Occasionally confirmatory drug testing will be necessary, particularly under the following conditions:
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The member appears intoxicated or impaired but point of care testing is negative;
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Results of point of care/presumptive testing yield unexpected results (possibly due to
metabolites from other medications or OTC products resulting in false positives);
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The member is negative for the prescribed substance(s) but denies diversion;
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The member is positive for illicit substances but denies use when confronted; and
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There is evidence that the sample was adulterated or altered in any way.
However, routine confirmatory testing is not recommended and could be viewed as overbilling, particularly if the clinician cannot justify the testing in his/her documentation.
The American Society of Addiction Medicine guidelines for drug screening, summarized in “Appropriate Use of Drug Testing in Clinical Addiction Medicine,” make the following recommendations:
Test Frequency: For people in addiction treatment, frequency of testing should be dictated by patient acuity and level of care. Providers should examine a test’s detection capabilities and windows of detection to determine the frequency of testing. Providers should understand that increasing the frequency of testing increases the likelihood of detection of substance use, but there is insufficient evidence that increasing the frequency of drug testing affects substance use itself.
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Drug testing should be scheduled more frequently at the beginning of treatment.
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Test frequency should be decreased as recovery progresses.
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When possible, testing should occur on a random schedule.
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Individual consideration may be given for less frequent testing if a patient is in stable recovery.
Random Testing: Unannounced drug tests are preferred to scheduled drug tests. A random-interval schedule is preferable to a fixed-interval schedule because it eliminates known non-testing periods (eg, if Monday is randomly selected from a week interval, the patient knows they will not be tested Tuesday-Saturday) and it is preferable to a truly random schedule because it limits the maximum number of days between tests.