CPT® Code 80364

Official Description

Opioids and Opiate analogs; 5 or more

Common Language Description

The CPT® Code 80364 refers to a laboratory test specifically designed to measure the presence of five or more opioids and opiate analogs in biological samples such as meconium stool, urine, serum, or plasma. Opioids and opiate analogs are a class of substances that include both naturally occurring opiates, such as codeine, morphine, and thebaine, as well as semi-synthetic opioids like hydromorphone, hydrocodone, oxycodone, oxymorphone, buprenorphine, meperidine, methadone, propoxyphene, tapentadol, and tramadol. These substances share a similar chemical structure and pharmacological effects, primarily acting as narcotic analgesics and central nervous system depressants. Clinically, they are prescribed to manage moderate to severe acute or chronic pain. However, due to their effects on the brain's pleasure centers, they can also induce a euphoric state, which may lead to potential abuse by recreational drug users. The testing process involves obtaining a blood sample through venipuncture, a urine sample via random void or catheterization, and collecting meconium stool from a diaper. The analysis of serum, plasma, urine, and stool is conducted using quantitative liquid chromatography-tandem mass spectrometry, a sophisticated technique that allows for precise measurement of these substances. It is important to note that CPT® Code 80362 is applicable for testing one or two opioids/opiate analogs, while CPT® Code 80363 is designated for three or four, and CPT® Code 80364 is specifically utilized when evaluating a sample for five or more opioids/opiate analogs.

1. Indications

The laboratory test represented by CPT® Code 80364 is indicated for the detection and quantification of five or more opioids and opiate analogs in various biological samples. This test is typically performed in the following scenarios:

Substance Abuse Evaluation This test is often utilized in the assessment of individuals suspected of opioid abuse or dependency, providing critical information regarding the presence of multiple opioids in their system.
Clinical Monitoring It is used for monitoring patients who are prescribed opioid medications to ensure compliance with treatment regimens and to detect any unauthorized use of additional opioids.
Forensic Analysis The test may be employed in forensic settings to investigate cases of overdose or death related to opioid use, helping to establish the presence of multiple substances.
Newborn Screening In cases where maternal opioid use is suspected, testing of meconium stool can provide insights into the exposure of newborns to opioids during gestation.

2. Procedure

The procedure for conducting the test associated with CPT® Code 80364 involves several key steps to ensure accurate collection and analysis of samples:

Sample Collection Blood samples are obtained through a process known as venipuncture, where a needle is inserted into a vein to draw blood. Urine samples can be collected either through random voiding by the patient or via catheterization if necessary. Additionally, meconium stool is collected from a diaper, which is particularly relevant in newborns to assess exposure to opioids.
Sample Preparation Once collected, the samples (serum, plasma, urine, and stool) are prepared for analysis. This preparation may involve processes such as centrifugation to separate components of the blood or specific handling techniques for urine and stool samples to ensure integrity and accuracy in testing.
Analytical Testing The prepared samples are then subjected to quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS). This advanced analytical technique allows for the precise measurement of the concentration of multiple opioids and opiate analogs within the samples, providing detailed results that can inform clinical decisions.

3. Post-Procedure

After the procedure, the samples are analyzed, and results are typically available within a specified timeframe, depending on the laboratory's processing capabilities. Clinicians will review the results to determine the presence and levels of opioids and opiate analogs. Based on these findings, further clinical actions may be taken, such as adjusting medication regimens, initiating treatment for substance use disorders, or conducting additional assessments. It is essential for healthcare providers to communicate the results to patients and discuss any necessary follow-up actions or interventions. Additionally, proper documentation of the test results and any subsequent clinical decisions is crucial for compliance and continuity of care.

Short Descr	OPIOID &OPIATE ANALOG 5/MORE
Medium Descr	DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE
Long Descr	Opioids and Opiate analogs; 5 or more
Status Code	Not Valid for Medicare Purposes
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T2D - Other tests - other
MUE	1

90	Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.