Urine Drug/Alcohol Testing — Commercial/Medicaid

Last Review Date: February 12, 2021 Number: MG.MM.LA.42aC2v2

Medical Guideline Disclaimer

Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the patient meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request for prior authorization. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. EmblemHealth Services Company LLC, (“EmblemHealth”) has adopted the herein policy in providing management, administrative and other services to EmblemHealth Plan, Inc., EmblemHealth Insurance Company, EmblemHealth Services Company, LLC and Health Insurance Plan of Greater New York (HIP) related to health benefit plans offered by these entities. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc.

Related Medical Guidelines

See NGS Local Coverage Determination (LCD): Urine Drug Testing (L36037) for Medicare members

Definitions (or Skip definitions and go directly to guideline) Urine drug/alcohol screening/testing is used to detect alcohol, prescription medications and illegal substances for the purpose of medical treatment. Presumptive, also known as screening testing, is testing used to indicate possible, but not definitive presence of drugs and or drug metabolites. Definitive, also known as confirmatory or identification testing (involves mass spectrometry methods) is testing to provide specific identification of individual drugs and or drug metabolites. Screening and testing should focus on the detection of specific drugs and not routinely include a panel of drugs of abuse. (See Limitations/Exclusions) Where Presumptive testing methods are available, the two laboratory urine drug testing methods to detect patient use of alcohol/drugs levels include:

Presumptive testing (qualitative or semi-quantitative; immunoassay or other non-specific methods)

Positive and inconsistent Negative presumptive results are followed/confirmed using Definitive testing (qualitative or quantitative; chromatographic and mass spectrometry methods

Where Presumptive testing methods are not available, Definitive testing is the only option to drug test

Presumptive/Qualitative Drug Testing “Presumptive" urine drug testing (UDT)

Used to identify possible use or non-use of a drug or drug class in a urine sample; results expressed qualitatively as negative or positive or semi-quantitatively. Includes competitive immunoassays (IA) (below row) and thin layer chromatography.

Immunoassay (IA) “Qualitative IA”

Used to identify the presence or absence of drug classes and some specific drugs; biochemical tests measure the presence above a cutoff level of a

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substance (drug) with the use of an antibody. Read by photometric technology. An IA involves an antibody that reacts best with the stimulating drug and reacts to a lesser extent (cross-reactive) or not at all with other drugs in the drug class. While presumptive tests vary in their ability to detect illicit drugs such as tetrahydrocannabinol (THC), cocaine, 3,4-methylenedioxy-N-methylamphetamine (MDMA; “ecstasy”) and phencyclidine (PCP), they may not be optimal tests for many prescription drugs, such as opiates, barbiturates, benzodiazepines and opioids.

Definitive/Quantitative/Confirmation “Definitive” UDT

Used to identify specific drugs associated with metabolites; reports the results of analytes negative or present (typically in concentrations such as ng/ml or may be qualitative reported as the name of the drugs and or drug metabolites). Definitive methods include but are not limited to gas chromatography coupled with mass spectrometry (GC-MS) and liquid chromatography (LC-MS/MS) testing methods only. These high-complexity tests as used to confirm presumptive results (positive or inconsistent) or used as the only method available and should be performed in a CLIA (CMS-certified) accredited laboratory where national quality control standards for testing and laboratory personnel training have been established. Note: The need for definitive testing must be substantiated in the medical record. See Section D4, Chronic Opioid therapy for clinical criteria.

Specimen Validity Testing Urine specimen testing to ensure that urine is consistent with normal human urine and has not been adulterated or substituted; may include, but is not limited to, pH, specific gravity, oxidants and creatinine. (See Limitations/Exclusions)

Point of Care Testing (POCT) Used when immediate test results are needed for the immediate management of the patient. POCT consists of an IA test method, which primarily identifies drug classes and a few specific drugs. Platform consists of cups, dipsticks, cassettes or strips; read by the human eye. (See Limitations/Exclusions)

Standing Orders Test request for a specific patient representing repetitive testing to monitor a condition or disease for a limited number of sequential visits; individualized orders for certain patients for pre-determined tests based on historical use, risk and community trend patient profiles. Clinician can alter the standing order. Note: A “profile” differs from a “panel” in that a profile responds to the clinical risks of a particular patient, whereas a panel may encourage unnecessary or excessive testing when no clinical cause exists for many of the tests.

Blanket Orders Test request that is not for a specific patient; rather, it is an identical order for all patients in a clinician’s practice without individualized decision making at every visit. (See Limitations/Exclusions)

Reflex Testing Laboratory testing that is performed "reflexively" after initial test results to identify further diagnostic information essential to patient care. (Testing performed as a step necessary to complete a physician’s order is not considered reflex testing)

Opioids Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain.

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Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths. An opioid overdose can be reversed with the drug naloxone when given right away

Heroin Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the Asian opium poppy plant. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin. Other common names for heroin include dope, horse, junk, and smack.

Fentanyl Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It is a schedule II prescription drug and is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic® and Sublimaze®. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT and Tango and Cash.

Naloxone Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.

Suboxone Suboxone (buprenorphine and naloxone) sublingual film is a partial-opioid agonist indicated for treatment of opioid dependence.

Note: Information regarding parent drugs and their metabolites may be found in Appendix A

Guideline A. Urine drug/alcohol testing is considered medically necessary when the following criteria are

met: 1. Medical record documentation substantiates that each test will impact treatment

2. If full panel screen is requested, medical record substantiates the need for a full panel (i.e., clinical rationale is provided for each of the drugs/drug classes to be screened with specific reference to any specialty test orders)

3. Documentation describes how results will impact the treatment plan (i.e., whether initial/continuation of treatment is medically reasonable based upon findings)

4. One of the following conditions is present: a. Altered mental status b. Medical/psychiatric condition where drug/alcohol toxicity may be a contributing

factor c. Perinatal maternal drug use (e.g. current pregnancy with possible exposure of

the fetus to illicit drugs taken by the mother, or history of recent delivery of infant diagnosed with Neonatal Abstinence/ Neonatal Withdrawal Syndrome)

d. Need to assess adherence to prescribed medications

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e. Need to assess and treat members with substance abuse disorders including alcohol

5. Drug confirmation is indicated if: a. Presumptive testing is positive

i. Will only cover the drug class represented by the positive screening ii. Will not cover if the results are confirmed by member’s self-disclosed

admission b. Confirmation by Definitive testing requires either a positive Presumptive

screening test or an inconsistent result and shall be performed only for the drug class represented by the positive screening or inconsistent result (See D4, Chronic opioid therapy for clinical criteria)

B. New patient screening — Presumptive IA with Definitive confirmation is considered medically necessary when all of the criteria in Section A are met. New patient screening typically involves the following drugs/drug classes: Alcohol, amphetamines/methamphetamine, barbiturates, cannabinoids, cocaine, methadone, opiates, oxycodone. Note: Request for specialty screening or direct-to-definitive analysis, for expanded benzodiazepines and opioid panels to determine the specific drugs in the member’s system, may be medically necessary if supported by documentation that substantiates the clinical rationale for the expanded test. (This includes a detailed justification for testing of specific metabolite)

C. On-going monitoring — typically sufficient with a Presumptive IA without the need for Definitive confirmation or quantitative testing unless documentation and specific rationale supports additional testing. (The need for testing [i.e., that it impacts treatment] must be established at each meeting with previous testing documented in the record)

D. Chronic opioid therapy 1. Presumptive drug and alcohol screens will only be covered if documentation includes all

of the following: History; current treatment plan; medication prescribed; risk potential for abuse, misuse and diversion accompanied by prescription drug monitoring data or pharmacy profile; use of a validated risk assessment interview (or questionnaire tool) with appropriate risk stratification and monitoring protocols

2. Periodic Presumptive monitoring is used to address risk potentials of abuse and diversion of controlled medications and/or abuse of illicit drugs, alcohol or drugs not prescribed as part of the treatment plan and obtained from an undisclosed/unsanctioned source

a. Documentation of the validated risk assessment process must establish that the need for testing impacts treatment

b. In the absence of specific symptoms of medication aberrant behavior or misuse, qualitative drug testing is only considered reasonable and necessary when titrated to patient risk potential

3. Targeting and select testing of limited drugs of abuse may be medically necessary when there is documentation of suspicious behaviors such as self-escalation of dose, doctor-shopping, indications/symptoms of illegal drug use, evidence of diversion or other documented change in affect or behavioral pattern

4. Definitive drug testing may be considered medically necessary when reliable validation (member self-report, prescription drug monitoring data, pharmacy profile,

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communication from prescribing clinician) is not available and ≥ 1 of the following is documented:

a. Member reports taking a prescribed opioid, but the Presumptive drug test is negative

b. Member tests Presumptive positive for cocaine and is believed to be a chronic cocaine user

c. Member tests Presumptive positive for THC, but documentation supports that the member is discontinuing THC according to the treatment plan

d. Presumptive tests are positive for stimulant, barbiturate or benzodiazepine class of drug

e. Presumptive test is negative and inconsistent with medical history and there is documentation to support the need for confirmatory testing (This does not apply to testing for cocaine, THC or amphetamines except if the member is receiving a prescription for amphetamine for attention deficit disorder [ADD]. The reason for the exception must be documented)

Note: Definitive testing may also be indicated if criteria for testing is met and there is documentation that a Presumptive test is not available (e.g., in the case of selected synthetic or semi-synthetic opioids)

Presumptive testing frequency for chronic opioid patients For targeted testing, frequency is based upon documentation of suspicious behaviors such as self-escalation of dose, doctor-shopping, indications/symptoms of illegal drug use, evidence of diversion or other documented change in affect or behavioral pattern. Presumptive testing for opioid pain management should be part of the pain management strategy and may be performed as follows:

A. Prior to initiating opioid therapy

B. At least annually

C. Every 3 months to assess effectiveness of the prescribed dose and decisions regarding tapering or increasing the dose are planned

Limitations/Exclusions A. Under Commercial plans, Presumptive and Definitive drug testing not to exceed one (1) unit per

date of service up to 18 units per year (12 months), submitted by the same or different provider. (Eff. 7/1/2020)

B. Under Medicaid plans, Presumptive and Definitive drug testing not to exceed one (1) unit per date of service up to 8 units per year (12 months), submitted by the same or different provider. Definitive drug tests codes G0481-G0483 are not covered. (Eff. 1/1/2021)

C. Blanket Orders (i.e., routine standing orders for all patients in a physician’s practice) are not considered reasonable and necessary are therefore not covered.

D. Coverage for point of care testing (POCT) is limited to dipstick screening.

E. Definitive testing requirements pertaining to lab performing test: 1. Test must be lab-based using the plan’s participating lab Quest Diagnostics™ 2. Use of a nonparticipating lab will be pended for review

F. Reflex Definitive UDT is not reasonable and necessary when Presumptive testing is performed at point of care because the clinician may have sufficient information to manage the member. If the clinician is not satisfied, he/she must determine the clinical appropriateness of and order

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specific subsequent Definitive testing (e.g., the member admits to using a particular drug, or the IA cut-off is set at such a point that is sufficiently low that the physician is satisfied with the Presumptive test result).

G. It is not reasonable and necessary for a physician to perform Presumptive POCT and order Presumptive IA testing from a reference laboratory (i.e., EmblemHealth will only pay for one Presumptive test result per member per date of service regardless of the number of billing providers).

H. It is not reasonable and necessary for a physician to perform Presumptive IA testing and order Presumptive IA testing from a reference laboratory with or without reflex testing (i.e., EmblemHealth will only pay for one Presumptive test result per member per date of service regardless of the number of billing providers).

I. It is not reasonable and necessary for a reference laboratory to perform and bill IA Presumptive UDT prior to Definitive testing without a specific physician’s order for the Presumptive testing.

J. Presumptive testing, regardless of whether it is qualitative or semi-quantitative (numerical), may not be used to “confirm” or definitively identify a Presumptive test result obtained by cups, dipsticks, cards, cassettes or other IA testing methods. Definitive UDT provides specific identification and/or quantification typically by GC-MS or LC-MS/MS.

K. Drug testing of two different specimen types from the same member on the same date of service for the same drugs/metabolites/analytes is not covered.

L. Drug tests ordered by, or on behalf of, third parties (e.g., courts, employers, schools, etc.) or to protect a physician from drug diversion charges, are not covered.

M. Specimen validity testing, including, but not limited to, pH, specific gravity, oxidants and/or creatinine is not covered. EmblemHealth will deny Specimen Validity Testing when performed by the same or different provider. (Eff. 7/1/2020)

N. High complexity testing is not covered in the office-based setting.

O. Testing of saliva, blood, hair and nails is not covered, as the medical necessity of such testing has not been established due to insufficient evidence of therapeutic value.

P. EmblemHealth does not reimburse for services pertaining to the evaluation of urine dilution (i.e, analysis of creatinine levels).

Q. Testing must coincide with a paid office visit.

R. Proprietary Laboratory Analysis (CPT codes 0006U, 0007U, or 0020U, 0011U) are not considered medically necessary and are not considered under the policy guidelines pertaining to definitive drug testing. (Eff. 7/1/2020)

S. Proprietary Laboratory Analysis (CPT code 0227U eff. 01/01/2021) is not considered medically necessary and is not considered under the policy guidelines pertaining to presumptive drug testing.

T. Under Commercial plans, 80320-80374 Drug test(s), individual types (Not reimbursed). (Eff. 7/1/2020)

U. Under Commercial plans, 80375-80377 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified (Not reimbursed). (Eff. 7/1/2020)

V. Confirmation testing when there hasn’t been an initial screen or confirmation testing conducted for drug classes other than the one(s) in question. For this reason, G0482-G0483 are considered

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not covered. G0481 must be appealed with documentation to support medical necessity. (Eff. 7/1/2020)

Place-of-Service (POS) Settings

POS 11 Office settings

POS 22 On Campus-Outpatient Hospital

POS 33 Custodial care facility

POS 49 Independent Clinic

POS 50 FQHC

POS 51 Partial Psych Hospital

POS 53 Community Mental Health

POS 55 Residential Substance Abuse Treatment

POS 56 Psych Rehab treatment

POS 57 Non-residential substance abuse center

POS 81 Independent Laboratory

Excluded All emergency and inpatient care locations

Revision History

Aug. 13, 2021 Clarified affected insurance plans under Limitation/Exclusions section

Sep. 2, 2021 Amendments to Limitations/Exclusions pertaining to Medicaid plans: Added non-coverage of G0481–G0483 Changed maximum annual allowance of presumptive and definitive drug testing from 16

units to 8 units

Dec. 17, 2019 Re-titled policy to reflect applicability to Commercial and Medicaid members Added hyperlink to Medicare LCD criteria Added reimbursement rules to Limitations/Exclusions Section denoting Mar. 18, 2020 effective date

Feb. 8, 2019 Removed guideline applicability solely to HMO Clarified test types/technical methodologies Updated Parent Drugs and Metabolite Chart in Appendix

May 16, 2018 Added POS 22 and 81

Applicable Procedure Codes A. Presumptive/Qualitative Drug/Alcohol Testing

80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service

80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); read by instrument assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service

80307 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg,

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DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service

Applicable Procedure Codes

B. Definitive/Quantitative Urine/Drug Testing

G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed

G0481* Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed

G0482 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed (Not Covered)

G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed (Not Covered)

G0659 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes

*See Limitations/Exclusions section

C. Specimen Validity Testing

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81000

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy

81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy

81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy

81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy

81005 Urinalysis; qualitative or semiquantitative, except immunoassays 82570 Creatinine; other source 83986 pH; body fluid, not otherwise specified

Applicable Diagnosis Codes

E87.2 Acidosis F10.11 Alcohol abuse, in remission

F0.130 Alcohol abuse with withdrawal, uncomplicated (eff. 10/01/2020) F10.131 Alcohol abuse with withdrawal delirium (eff. 10/01/2020) F10.132 Alcohol abuse with withdrawal with perceptual disturbance (eff. 10/01/2020) F10.139 Alcohol abuse with withdrawal, unspecified (eff. 10/01/2020) F10.20 Alcohol dependence, uncomplicated F10.220 Alcohol dependence with intoxication, uncomplicated

F10.221 Alcohol dependence with intoxication delirium F10.229 Alcohol dependence with intoxication, unspecified F10.230 Alcohol dependence with withdrawal, uncomplicated F10.231 Alcohol dependence with withdrawal delirium F10.232 Alcohol dependence with withdrawal with perceptual disturbance F10.239 Alcohol dependence with withdrawal, unspecified

F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified F10.280 Alcohol dependence with alcohol-induced anxiety disorder F10.281 Alcohol dependence with alcohol-induced sexual dysfunction F10.282 Alcohol dependence with alcohol-induced sleep disorder

F10.288 Alcohol dependence with other alcohol-induced disorder F10.29 Alcohol dependence with unspecified alcohol-induced disorder F10.930 Alcohol use, unspecified with withdrawal, uncomplicated (eff. 10/01/2020) F10.931 Alcohol use, unspecified with withdrawal delirium (eff. 10/01/2020) F10.932 Alcohol use, unspecified with withdrawal with perceptual (eff. 10/01/2020) F10.939 Alcohol use, unspecified with withdrawal, unspecified (eff. 10/01/2020)

F11.11 Opioid abuse, in remission F11.13 Opioid abuse with withdrawal (eff. 10/01/2021) F11.20 Opioid dependence, uncomplicated F11.220 Opioid dependence with intoxication, uncomplicated

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F11.221 Opioid dependence with intoxication delirium F11.222 Opioid dependence with intoxication with perceptual disturbance F11.229 Opioid dependence with intoxication, unspecified F11.23 Opioid dependence with withdrawal F11.24 Opioid dependence with opioid-induced mood disorder

F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified F11.281 Opioid dependence with opioid-induced sexual dysfunction F11.282 Opioid dependence with opioid-induced sleep disorder F11.288 Opioid dependence with other opioid-induced disorder

F11.29 Opioid dependence with unspecified opioid-induced disorder F12.11 Cannabis abuse, in remission F12.13 Cannabis abuse with withdrawal (eff. 10/01/2020) F12.20 Cannabis dependence, uncomplicated F12.23 Cannabis dependence with withdrawal F12.220 Cannabis dependence with intoxication, uncomplicated F12.221 Cannabis dependence with intoxication delirium

F12.222 Cannabis dependence with intoxication with perceptual disturbance F12.229 Cannabis dependence with intoxication, unspecified F12.250 Cannabis dependence with psychotic disorder with delusions F12.251 Cannabis dependence with psychotic disorder with hallucinations F12.259 Cannabis dependence with psychotic disorder, unspecified F12.280 Cannabis dependence with cannabis-induced anxiety disorder

F12.288 Cannabis dependence with other cannabis-induced disorder F12.29 Cannabis dependence with unspecified cannabis-induced disorder F13.11 Sedative, hypnotic or anxiolytic abuse, in remission F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium (eff. 10/01/2020) F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance (eff. 10/01/2020)

F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified (eff. 10/01/2020) F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated F13.220 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified F13.230 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated

F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified F13.239 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic

disorder with delusions F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic

disorder with hallucinations F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic

disorder, unspecified

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F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia

F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.281 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.282 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.288 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder F13.29 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced

disorder F14.11 Cocaine abuse, in remission F14.13 Cocoanie abuse, unspecified with withdrawal (eff. 10/01/2020)

F14.20 Cocaine dependence, uncomplicated F14.220 Cocaine dependence with intoxication, uncomplicated F14.221 Cocaine dependence with intoxication delirium F14.222 Cocaine dependence with intoxication with perceptual disturbance F14.229 Cocaine dependence with intoxication, unspecified F14.23 Cocaine dependence with withdrawal

F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified F14.280 Cocaine dependence with cocaine-induced anxiety disorder F14.281 Cocaine dependence with cocaine-induced sexual dysfunction F14.282 Cocaine dependence with cocaine-induced sleep disorder

F14.288 Cocaine dependence with other cocaine-induced disorder F14.29 Cocaine dependence with unspecified cocaine-induced disorder F14.93 Cocaine use , unspecified with withdrawal (eff. 10/01/2020) F15.11 Other stimulant abuse, in remission F15.13 Other stimulant abuse with withdrawal (eff. 10/01/2020) F15.20 Other stimulant dependence, uncomplicated

F15.220 Other stimulant dependence with intoxication, uncomplicated F15.221 Other stimulant dependence with intoxication delirium F15.222 Other stimulant dependence with intoxication with perceptual disturbance F15.229 Other stimulant dependence with intoxication, unspecified F15.23 Other stimulant dependence with withdrawal F15.24 Other stimulant dependence with stimulant-induced mood disorder

F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified F15.280 Other stimulant dependence with stimulant-induced anxiety disorder F15.281 Other stimulant dependence with stimulant-induced anxiety disorder F15.282 Other stimulant dependence with stimulant-induced sleep disorder

F15.288 Other stimulant dependence with other stimulant-induced disorder F15.29 Other stimulant dependence with unspecified stimulant-induced disorder F16.11 Hallucinogen abuse, in remission

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F16.20 Hallucinogen dependence, uncomplicated F16.220 Hallucinogen dependence with intoxication, uncomplicated F16.221 Hallucinogen dependence with intoxication with delirium F16.229 Hallucinogen dependence with intoxication, unspecified F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder

F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks) F16.288 Hallucinogen dependence with other hallucinogen-induced disorder

F16.29 Hallucinogen dependence with unspecified hallucinogen-induced disorder F18.10 Inhalant abuse, uncomplicated F18.11 Inhalant abuse, in remission F18.120 Inhalant abuse with intoxication, uncomplicated F18.20 Inhalant dependence, uncomplicated F18.220 Inhalant dependence with intoxication, uncomplicated F18.221 Inhalant dependence with intoxication delirium

F18.229 Inhalant dependence with intoxication, unspecified F18.24 Inhalant dependence with inhalant-induced mood disorder F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified F18.27 Inhalant dependence with inhalant-induced dementia

F18.280 Inhalant dependence with inhalant-induced anxiety disorder F18.288 Inhalant dependence with other inhalant-induced disorder F18.29 Inhalant dependence with unspecified inhalant-induced disorder F18.90 Inhalant use, unspecified, uncomplicated F19.11 Other psychoactive substance abuse, in remission F19.130 Other psychoactive substance abuse with withdrawal uncomplicated (eff. 10/01/2020)

F19.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium (eff. 10/01/2020) F19.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance (eff. 10/01/2020) F19.139 Other psychoactive substance abuse with withdrawal, unspecified (eff. 10/01/2020) F19.20 Other psychoactive substance dependence, uncomplicated F19.220 Other psychoactive substance dependence with intoxication, uncomplicated F19.221 Other psychoactive substance dependence with intoxication delirium

F19.222 Other psychoactive substance dependence with intoxication with perceptual disturbance F19.229 Other psychoactive substance dependence with intoxication, unspecified F19.230 Other psychoactive substance dependence with withdrawal, uncomplicated F19.231 Other psychoactive substance dependence with withdrawal delirium F19.232 Other psychoactive substance dependence with withdrawal with perceptual disturbance F19.239 Other psychoactive substance dependence with withdrawal, unspecified

F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with

delusions

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F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations

F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified

F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder

F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia F19.280 Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder F19.281 Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction

F19.282 Other psychoactive substance dependence with psychoactive substance-induced sleep disorder F19.288 Other psychoactive substance dependence with other psychoactive substance-induced disorder F19.29 Other psychoactive substance dependence with unspecified psychoactive substance-induced disorder F20.0 Paranoid schizophrenia F20.1 Disorganized schizophrenia F20.2 Catatonic schizophrenia

F20.89 Other schizophrenia F55.0 Abuse of antacids F55.1 Abuse of herbal or folk remedies F55.2 Abuse of laxatives F55.3 Abuse of steroids or hormones F55.4 Abuse of vitamins F55.8 Abuse of other non-psychoactive substances

G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus G40.401 Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus G40.409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus

G40.411 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus G40.419 Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus G40.901 Epilepsy, unspecified, not intractable, with status epilepticus G40.909 Epilepsy, unspecified, not intractable, without status epilepticus G40.911 Epilepsy, unspecified, intractable, with status epilepticus G40.919 Epilepsy, unspecified, intractable, without status epilepticus

G89.29 Other chronic pain G89.4 Chronic pain syndrome I44.0 Atrioventricular block, first degree I44.1 Atrioventricular block, second degree I44.30 Unspecified atrioventricular block I45.81 Long QT syndrome

I47.0 Re-entry ventricular arrhythmia I47.1 Supraventricular tachycardia I47.2 Ventricular tachycardia I49.2 Junctional premature depolarization M25.50 Pain in unspecified joint M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region

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M47.22 Other spondylosis with radiculopathy, cervical region M47.23 Other spondylosis with radiculopathy, cervicothoracic region M47.26 Other spondylosis with radiculopathy, lumbar region M47.27 Other spondylosis with radiculopathy, lumbar region M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region

M47.811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region M47.812 Spondylosis without myelopathy or radiculopathy, cervical region M47.813 Spondylosis without myelopathy or radiculopathy, cervicothoracic region M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region

M47.891 Other spondylosis, occipito-atlanto-axial region M47.892 Other spondylosis, cervical region M47.893 Other spondylosis, cervicothoracic region M47.896 Other spondylosis, lumbar region M47.897 Other spondylosis, lumbosacral region M47.898 Other spondylosis, sacral and sacrococcygeal region M51.14 Intervertebral disc disorders with radiculopathy, thoracic region

M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region M51.16 Intervertebral disc disorders with radiculopathy, lumbar region M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region M51.36 Other intervertebral disc degeneration, lumbar region M51.37 Other intervertebral disc degeneration, lumbosacral region M54.14 Radiculopathy, thoracic region

M54.15 Radiculopathy, thoracolumbar region M54.16 Radiculopathy, lumbar region M54.17 Radiculopathy, lumbosacral region M54.18 Radiculopathy, sacral and sacrococcygeal region M54.2 Cervicalgia M54.5 Low back pain

M60.811 Other myositis, right shoulder M60.812 Other myositis, left shoulder M60.821 Other myositis, right upper arm M60.822 Other myositis, left upper arm M60.831 Other myositis, right forearm M60.832 Other myositis, left forearm

M60.841 Other myositis, right hand M60.842 Other myositis, left hand M60.851 Other myositis, right thigh M60.852 Other myositis, left thigh M60.861 Other myositis, right lower leg M60.862 Other myositis, left lower leg

M60.871 Other myositis, right ankle and foot M60.872 Other myositis, left ankle and foot M60.88 Other myositis, other site

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M60.89 Other myositis, multiple sites M60.9 Myositis, unspecified M79.1 Myalgia M79.2 Neuralgia and neuritis, unspecified M79.7 Fibromyalgia

R40.0 Somnolence R40.1 Stupor R40.20 Unspecified coma R40.2110 Coma scale, eyes open, never, unspecified time R40.2111 Coma scale, eyes open, never, at arrival to emergency department R40.2112 Coma scale, eyes open, never, at hospital admission

R40.2113 Coma scale, eyes open, never, 24 hours or more after hospital admission R40.2114 Coma scale, eyes open, to pain, unspecified time R40.2120 Coma scale, eyes open, to pain, unspecified time R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance] R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department R40.2123 Coma scale, eyes open, to pain, at hospital admission R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission

R40.2210 Coma scale, best verbal response, none, unspecified time R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance] R40.2212 Coma scale, best verbal response, none, at arrival to emergency department R40.2213 Coma scale, best verbal response, none, at hospital admission R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time

R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance] R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission R40.2310 Coma scale, best motor response, none, unspecified time R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]

R40.2312 Coma scale, best motor response, none, at arrival to emergency department R40.2313 Coma scale, best motor response, none, at hospital admission R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission R40.2320 Coma scale, best motor response, extension, unspecified time R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance] R40.2322 Coma scale, best motor response, extension, at arrival to emergency department

R40.2323 Coma scale, best motor response, extension, at hospital admission R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance] R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission

R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission R41.82 Altered mental status, unspecified R44.0 Auditory hallucinations

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R44.2 Other hallucinations R44.3 Hallucinations, unspecified R56.9 Unspecified convulsions T14.91XA Suicide attempt, initial encounter T14.91XD Suicide attempt, subsequent encounter

T14.91XS Suicide attempt, sequela T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter T39.012A Poisoning by aspirin, intentional self-harm, initial encounter T39.013A Poisoning by aspirin, assault, initial encounter T39.014A Poisoning by aspirin, undetermined, initial encounter T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter

T39.092A Poisoning by salicylates, intentional self-harm, initial encounter T39.093A Poisoning by salicylates, assault, initial encounter T39.094A Poisoning by salicylates, undetermined, initial encounter T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental (unintentional), initial encounter T39.1X2A Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter T39.1X3A Poisoning by 4-Aminophenol derivatives, assault, initial encounter T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, initial encounter

T39.2X1A Poisoning by pyrazolone derivatives, accidental (unintentional), initial encounter T39.2X2A Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter T39.2X3A Poisoning by pyrazolone derivatives, assault, initial encounter T39.2X4A Poisoning by pyrazolone derivatives, undetermined, initial encounter T39.311A Poisoning by propionic acid derivatives, accidental (unintentional), initial encounter T39.312A Poisoning by propionic acid derivatives, intentional self-harm, initial encounter

T39.313.A Poisoning by propionic acid derivatives, assault, initial encounter T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter T39.391A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], accidental (unintentional), initial

encounter T39.392A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm, initial encounter

T39.393A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], assault, initial encounter T39.394A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], undetermined, initial encounter T40.0X1A Poisoning by opium, accidental (unintentional), initial encounter T40.0X2A Poisoning by opium, intentional self-harm, initial encounter T40.0X3A Poisoning by opium, assault, initial encounter T40.0X4A Poisoning by opium, undetermined, initial encounter

T40.1X1A Poisoning by heroin, accidental (unintentional), initial encounter T40.1X2A Poisoning by heroin, intentional self-harm, initial encounter T40.1X3A Poisoning by heroin, assault, initial encounter T40.1X4A Poisoning by heroin, undetermined, initial encounter T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter T40.2X2A Poisoning by other opioids, intentional self-harm, initial encounter

T40.2X3A Poisoning by other opioids, assault, initial encounter T40.2X4A Poisoning by other opioids, undetermined, initial encounter T40.3X1A Poisoning by methadone, accidental (unintentional), initial encounter T40.3X2A Poisoning by methadone, intentional self-harm, initial encounter

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T40.3X3A Poisoning by methadone, assault, initial encounter T40.3X4A Poisoning by methadone, undetermined, initial encounter T40.4X1A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter (del. 10/01/2020) T40.4X2A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter (del. 10/01/2020) T40.4X3A Poisoning by other synthetic narcotics, assault, initial encounter (del. 10/01/2020)

T40.4X4A Poisoning by other synthetic narcotics, undetermined, initial encounter (del. 10/01/2020) T40.411A Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), initial encounter (eff. 10/01/2020) T40.411D Poisoning by fentanyl or fentanyl analogs, accidental (unintention al), subsequent encounter (eff.

10/01/2020) T40.411S Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), sequela (eff. 10/01/2020) T40.412A Poisoning by fentanyl or fentanyl analogs, intentional self-harm, initial encounter

T40.412D Poisoning by fentanyl or fentanyl analogs, intentional self-harm, subsequent encounter T40.412S Poisoning by fentanyl or fentanyl analogs, intentional self-harm, sequela T40.413A Poisoning by fentanyl or fentanyl analogs, assault, initial encounter (eff. 10/01/2020) T40.413D Poisoning by fentanyl or fentanyl analogs, assault, subsequent encounter (eff. 10/01/2020) T40.413S Poisoning by fentanyl or fentanyl analogs, assault, sequela (eff. 10/01/2020) T40.5X1A Poisoning by cocaine, accidental (unintentional), initial encounter

T40.5X2A Poisoning by cocaine, intentional self-harm, initial encounter T40.5X3A Poisoning by cocaine, assault, initial encounter T40.5X4A Poisoning by cocaine, undetermined, initial encounter T40.601A Poisoning by unspecified narcotics, accidental (unintentional), initial encounter T40.602A Poisoning by unspecified narcotics, intentional self-harm, initial encounter T40.603A Poisoning by unspecified narcotics, assault, initial encounter

T40.604A Poisoning by unspecified narcotics, undetermined, initial encounter T40.691A Poisoning by other narcotics, accidental (unintentional), initial encounter T40.692A Poisoning by other narcotics, intentional self-harm, initial encounter T40.693A Poisoning by other narcotics, assault, initial encounter T40.694A Poisoning by other narcotics, undetermined, initial encounter T40.7X1A Poisoning by cannabis (derivatives), accidental (unintentional), initial encounter

T40.7X2A Poisoning by cannabis (derivatives), intentional self-harm, initial encounter T40.7X3A Poisoning by cannabis (derivatives), assault, initial encounter T40.7X4A Poisoning by cannabis (derivatives), undetermined, initial encounter T40.8X1A Poisoning by lysergide [LSD], accidental (unintentional), initial encounter T40.8X2A Poisoning by lysergide [LSD], intentional self-harm, initial encounter T40.8X3A Poisoning by lysergide [LSD], assault, initial encounter

T40.8X4A Poisoning by lysergide [LSD], undetermined, initial encounter T40.901A Poisoning by unspecified psychodysleptics [hallucinogens], accidental (unintentional), initial encounter T40.902A Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm, initial encounter T40.903A Poisoning by unspecified psychodysleptics [hallucinogens], assault, initial encounter T40.904A Poisoning by unspecified psychodysleptics [hallucinogens], undetermined, initial encounter T40.991A Poisoning by other psychodysleptics [hallucinogens], accidental (unintentional), initial encounter

T40.992A Poisoning by other psychodysleptics [hallucinogens], intentional self-harm, initial encounter T40.993A Poisoning by other psychodysleptics [hallucinogens], assault, initial encounter T40.994A Poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter T42.0X1A Poisoning by hydantoin derivatives, accidental (unintentional), initial encounter

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T42.0X2A Poisoning by hydantoin derivatives, intentional self-harm, initial encounter T42.0X3A Poisoning by hydantoin derivatives, assault, initial encounter T42.0X4A Poisoning by hydantoin derivatives, undetermined, initial encounter T42.3X1A Poisoning by barbiturates, accidental (unintentional), initial encounter T42.3X2A Poisoning by barbiturates, intentional self-harm, initial encounter

T42.3X3A Poisoning by barbiturates, assault, initial encounter T42.3X4A Poisoning by barbiturates, undetermined, initial encounter T42.4X1A Poisoning by benzodiazepines, accidental (unintentional), initial encounter T42.4X2A Poisoning by benzodiazepines, intentional self-harm, initial encounter T42.4X3A Poisoning by benzodiazepines, assault, initial encounter T42.4X4A Poisoning by benzodiazepines, undetermined, initial encounter

T42.6X1A Poisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter T42.6X2A Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter T42.6X3A Poisoning by other antiepileptic and sedative-hypnotic drugs, assault, initial encounter T42.6X4A Poisoning by other antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter T42.71XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial

encounter T42.72XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial

encounter T42.73XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter T42.74XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter T43.011A Poisoning by tricyclic antidepressants, accidental (unintentional), initial encounter

T43.012A Poisoning by tricyclic antidepressants, intentional self-harm, initial encounter T43.013A Poisoning by tricyclic antidepressants, assault, initial encounter T43.014A Poisoning by tricyclic antidepressants, undetermined, initial encounter T43.021A Poisoning by tetracyclic antidepressants, accidental (unintentional), initial encounter T43.022A Poisoning by tetracyclic antidepressants, intentional self-harm, initial encounter T43.023A Poisoning by tetracyclic antidepressants, assault, initial encounter

T43.024A Poisoning by tetracyclic antidepressants, undetermined, initial encounter T43.1X1A Poisoning by monoamine-oxidase-inhibitor antidepressants, accidental (unintentional), initial encounter T43.1X2A Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional self-harm, initial encounter T43.1X3A Poisoning by monoamine-oxidase-inhibitor antidepressants, assault, initial encounter T43.1X4A Poisoning by monoamine-oxidase-inhibitor antidepressants, undetermined, initial encounter T43.201A Poisoning by unspecified antidepressants, accidental (unintentional), initial encounter

T43.202A Poisoning by unspecified antidepressants, intentional self-harm, initial encounter T43.203A Poisoning by unspecified antidepressants, assault, initial encounter T43.204A Poisoning by unspecified antidepressants, undetermined, initial encounter T43.211A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, accidental (unintentional),

initial encounter T43.212A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm, initial

encounter T43.213A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, assault, initial encounter T43.214A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, undetermined, initial encounter T43.221A Poisoning by selective serotonin reuptake inhibitors, accidental (unintentional), initial encounter T43.222A Poisoning by selective serotonin reuptake inhibitors, intentional self-harm, initial encounter

T43.223A Poisoning by selective serotonin reuptake inhibitors, assault, initial encounter T43.224A Poisoning by selective serotonin reuptake inhibitors, undetermined, initial encounter

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T43.291A Poisoning by other antidepressants, accidental (unintentional), initial encounter T43.292A Poisoning by other antidepressants, intentional self-harm, initial encounter T43.293A Poisoning by other antidepressants, assault, initial encounter T43.294A Poisoning by other antidepressants, undetermined, initial encounter T43.3X1A Poisoning by phenothiazine antipsychotics and neuroleptics, accidental (unintentional), initial encounter

T43.3X2A Poisoning by phenothiazine antipsychotics and neuroleptics, intentional self-harm, initial encounter T43.3X3A Poisoning by phenothiazine antipsychotics and neuroleptics, assault, initial encounter T43.3X4A Poisoning by phenothiazine antipsychotics and neuroleptics, undetermined, initial encounter T43.4X1A Poisoning by butyrophenone and thiothixene neuroleptics, accidental (unintentional), initial encounter T43.4X2A Poisoning by butyrophenone and thiothixene neuroleptics, intentional self-harm, initial encounter T43.4X3A Poisoning by butyrophenone and thiothixene neuroleptics, assault, initial encounter

T43.4X4A Poisoning by butyrophenone and thiothixene neuroleptics, undetermined, initial encounter T43.501A Poisoning by unspecified antipsychotics and neuroleptics, accidental (unintentional), initial encounter T43.502A Poisoning by unspecified antipsychotics and neuroleptics, intentional self-harm, initial encounter T43.503A Poisoning by unspecified antipsychotics and neuroleptics, assault, initial encounter T43.504A Poisoning by unspecified antipsychotics and neuroleptics, undetermined, initial encounter T43.591A Poisoning by other antipsychotics and neuroleptics, accidental (unintentional), initial encounter T43.592A Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter

T43.593A Poisoning by other antipsychotics and neuroleptics, assault, initial encounter T43.594A Poisoning by other antipsychotics and neuroleptics, undetermined, initial encounter T43.601A Poisoning by unspecified psychostimulants, accidental (unintentional), initial encounter T43.602A Poisoning by unspecified psychostimulants, intentional self-harm, initial encounter T43.603A Poisoning by unspecified psychostimulants, assault, initial encounter T43.604A Poisoning by unspecified psychostimulants, undetermined, initial encounter

T43.611A Poisoning by caffeine, accidental (unintentional), initial encounter T43.612A Poisoning by caffeine, intentional self-harm, initial encounter T43.613A Poisoning by caffeine, assault, initial encounter T43.614A Poisoning by caffeine, undetermined, initial encounter T43.621A Poisoning by amphetamines, accidental (unintentional), initial encounter T43.622A Poisoning by amphetamines, accidental (unintentional), initial encounter

T43.623A Poisoning by amphetamines, assault, initial encounter T43.624A Poisoning by amphetamines, undetermined, initial encounter T43.631A Poisoning by methylphenidate, accidental (unintentional), initial encounter T43.632A Poisoning by methylphenidate, intentional self-harm, initial encounter T43.633A Poisoning by methylphenidate, assault, initial encounter T43.634A Poisoning by methylphenidate, undetermined, initial encounter

T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter T43.641D Poisoning by ecstasy, accidental (unintentional), subsequent encounter T43.641S Poisoning by ecstasy, accidental (unintentional), sequela T43.642A Poisoning by ecstasy, intentional self-harm, initial encounter T43.642D Poisoning by ecstasy, intentional self-harm, subsequent encounter T43.642S Poisoning by ecstasy, intentional self-harm, sequela

T43.643A Poisoning by ecstasy, assault, initial encounter T43.643D Poisoning by ecstasy, assault, subsequent encounter T43.643S Poisoning by ecstasy, assault, sequela

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T43.644A Poisoning by ecstasy, undetermined, initial encounter T43.644D Poisoning by ecstasy, undetermined, subsequent encounter T43.644S Poisoning by ecstasy, undetermined, sequela T43.691A Poisoning by other psychostimulants, accidental (unintentional), initial encounter T43.692A Poisoning by other psychostimulants, intentional self-harm, initial encounter

T43.693A Poisoning by other psychostimulants, assault, initial encounter T43.694A Poisoning by other psychostimulants, undetermined, initial encounter T43.8X1A Poisoning by other psychotropic drugs, accidental (unintentional), initial encounter T43.8X2A Poisoning by other psychotropic drugs, intentional self-harm, initial encounter T43.8X3A Poisoning by other psychotropic drugs, assault, initial encounter T43.8X4A Poisoning by other psychotropic drugs, undetermined, initial encounter

T43.91XA Poisoning by unspecified psychotropic drug, accidental (unintentional), initial encounter T43.92XA Poisoning by unspecified psychotropic drug, intentional self-harm, initial encounter T43.93XA Poisoning by unspecified psychotropic drug, assault, initial encounter T43.94XA Poisoning by unspecified psychotropic drug, undetermined, initial encounter T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), initial encounter T45.0X2A Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter T45.0X3A Poisoning by antiallergic and antiemetic drugs, assault, initial encounter

T45.0X4A Poisoning by antiallergic and antiemetic drugs, undetermined, initial encounter T46.0X1A Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), initial

encounter T46.0X2A Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial

encounter T46.0X3A Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, initial encounter T46.0X4A Poisoning by antiallergic and antiemetic drugs, undetermined, initial encounter T50.901A Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial

encounter T50.902A Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm, initial

encounter T50.903A Poisoning by unspecified drugs, medicaments and biological substances, assault, initial encounter T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter Z51.81 Encounter for therapeutic drug level monitoring Z79.3 Long term (current) use of hormonal contraceptives

Z79.891 Long term (current) use of opiate analgesic Z79.899 Other long term (current) drug therapy Z91.19 Patient's noncompliance with other medical treatment and regimen

References 1. American Society of Addiction Medicine (ASAM). October 2010. Drug testing as a component of addiction

2. American Society of Addiction Medicine (ASAM). The ASAM national practice guideline for the use of medications in the treatment of addiction involving opioid use. June 2015. https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf?sfvrsn=24#search="the. Accessed February 16, 2021.

3. American Society of Addiction Medicine. Drug testing: a white paper of the American Society of Addiction Medicine (ASAM). October 2013. https://www.asam.org/advocacy/find-a-policy-statement/archived-public-policy-statements/public-policy-statements/2013/12/12/drug-testing-a-white-paper. Accessed February 16, 2021.

4. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009 Feb;10(2):113-30. 8.

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5. Christo PJ, Manchikanti L, Ruan X, Bottros M, Hansen H, Solanki DR, Jordan AE, Colson J. Urine drug testing in chronic pain. Pain Physician. 2011 Mar-Apr;14(2):123-43. 9.

6. Chronic Non-Cancer Pain: An educational aid to improve care and safety with opioid therapy. 2010

7. Dupouy J, Mémier V, Catala H, Lavit M, Oustric S, Lapeyre-Mestre M. Does urine drug abuse screening help for managing patients? A systematic review. Drug Alcohol Depend. 2014 Mar 1;136:11-20.

8. Federation of State Medical Boards (FSMB), Model Policy for the Use of Opioid Analgesics for the Treatment of Chronic Pain, April 2017. https://www.fsmb.org/siteassets/advocacy/policies/opioid_guidelines_as_adopted_april-2017_final.pdf. Accessed February 16, 2021.

9. Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, Boswell MV, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic noncancer pain: part 2 - guidance. Pain Physician. 2012 Jul;15(3 Suppl):S67-S116.

10. Melanson Stacy EF, Baskin LB. Interpretation and utility of drug of abuse immunoassays: lessons from laboratory drug testing surveys. Arch Pathol Lab Med. 2010;134:736-739.

11. National Institute on Drug Abuse. Opioids. https://www.drugabuse.gov/drugs-abuse/opioids. Accessed February 16, 2021.

12. Substance Abuse and Mental Health Services Administration. Clinical Drug Testing in Primary Care. Technical Assistance Publication (TAP) 32. HHS Publication No. (SMA) 12-4668. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

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14. American Society of Addiction Medicine. Drug Testing as a Component of Treatment and Monitoring Programs and in Other Clinical Settings. https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/drug-testing-as-a-component-of-addiction-treatment-and-monitoring-programs-and-in-other-clinical-settings. Accessed February 16, 2021.

15. U.S. Preventive Services Task Force. Drug Use, Illicit: Screening. June 2020. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/drug-use-illicit-screening. Accessed February 16, 2021.

16. Washington State Agency Medical Directors Group. Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: 2010 Update. http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf. Accessed February 16, 2021.

17. Specialty matched clinical peer review.

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Appendix A

Parent Drugs and Metabolite Chart

The following chart (not all inclusive) illustrates parent drugs and their metabolites. Note: Ethanol is a significant drug of abuse. Alcohol metabolites of ethyl glucuronide and ethyl sulfate are typically detected by definitive (GC-MS or LC-MS/MS) UDT, and should only be performed based on clinician’s documentation of medical necessity.

Drug Class/Drugs Common Names General Monitoring Possibilities Subject to Medical Necessity

Alcohol/Alcohol Metabolites Ethyl Glucuronide Ethyl Sulfate

Alcohol Ethyl Glucuronide Ethyl Sulfate

Barbiturates Amobarbital Butabarbital Butalbital Pentobarbital Phenobarbital Secobarbital

Amytal Sodium® Butisol Sodium®, Butibel Fiorinal®, Fioricet® Nembutal® Belladona, Luminal® Seconal®

Amobarbital Butabarbital Butalbital Pentobarbital Phenobarbital Secobarbital

Benzodiazepines Alprazolam Chlordiazepoxide Clonazepam Clorazepate Diazepam Lorazepam Oxazepam Temazepam

Xanax®, Niravam®, Xanor Librax®, Libritabs Klonopin® Tranxene® Valium® Ativan®, Lorax Adumbran, Alepam, Murelax, Serax, Serepax Restoril®, Tenox, Euhypnos

Alprazolam, Alpha-hydroxyalprazolam Nordiazepam, Oxazepam 7-Aminoclonazepam Nordiazepam, Oxazepam Diazepam, Nordiazepam, Temazepam, Oxazepam Lorazepam Oxazepam Temazepam, Oxazepam

Illicit Drugs Cocaine Heroin

Blow, Coke, Crack, Snow Black Tar, Brown Sugar, Dragon, H, Horse, Tar Marinol, Pot, Reefer, Weed

Benzoylecgonine 6-MAM, Morphine THC-COOH

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Drug Class/Drugs Common Names General Monitoring Possibilities Subject to Medical Necessity

Marijuana MDA MDMA Methamphetamine Phencylclidine (PCP)

Ecstasy, X Ecstasy, X Crank, Crystal Meth, Didrex®, Eldepryl®, Ice Angel Dust

Methylenedioxyamphetamine Methylenedioxymethamphetamine, Methylenedioxyamphetamine Methamphetamine, Amphetamine Phencyclidine

Synthetic Cannabinoids "K2"/"Spice"

Cathinones

"Bath Salts" Kratom

Alpha-PVP Butylone MDPV Mephedrone Methylone Pentylone

General Anesthetic Ketamine

Ketalar®

Ketamine Norketamine

Muscle Relaxants Carisoprodol Meprobamate

Soma®, Soprodoal Equinal, Miltown®, Meprospan

Carisoprodol, Meprobamate Meprobamate

Neuroleptics

Neurontin® Lyrica®

Gabapentin Pregabalin

Opiates Codeine Hydrocodone Hydromorphone Morphine Oxycodone Oxymorphone

Tylenol® 3 Hycodan®, Lorcet®, Lortab®, Norco® Vicodin®, Vicoprofen® Dilaudid®, Exalgo®, Hymorphan Avinza®, Kadian®, MS Contin®, MSER, MSIR, Roxanol OxyContin®, OxyIR®, Percocet®, Percodan®, Roxicodone®, Tylox® Numorphan®, Opana® ER, Opana®

Codeine, Morphine Hydrocodone, Hydromorphone, Norhydrocodone Hydromorphone Morphine Oxycodone, Oxymorphone, Noroxycodone Oxymorphone

Opioids Buprenorphine Fentanyl Meperidine Methadone

Buprenex®, Butrans®, Suboxone®, Subutex® Actiq®, Duragesic®, Fentora®, Onsolis® Sublimaze Demerol®, Mepergan® Dolophine®, Methadose®

Buprenorphine, Norbuprenorphine Fentanyl, Norfentanyl Meperidine, Normeperidine Methadone, EDDP Propoxyphene, Norpropoxyphene

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Drug Class/Drugs Common Names General Monitoring Possibilities Subject to Medical Necessity

Propoxyphene Tapentadol Tramadol

Darvocet®, Darvon® Nucynta® Ryzolt®, Ultracet®, Ultram®, Tramadol

Tapentadol, N-Desmethyltapentadol Tramadol, O-Desmethyltramadol

Stimulants Amphetamine Methylphenidate Nicotine

Adderall®, Benzedrine, Dexedrine®, Vyvanse® Concerta®, Focalin®, Methylin®, Ritalin® Nicoderm®, Nicorette®

Amphetamine Methylphenidate, Ritalinic Acid Cotinine