Drug Screening in Pain Management Practices: Choosing a Reference Laboratory

Welcome back to our continuing series designed to provide you with information on urine drug screening in pain management practices.

Choosing a reference laboratory to compliment your in-house testing can be a challenge. Regardless of the level of testing performed in-house, the selection of a reference laboratory to provide supplemental and or confirmation testing requires some investigation and diligence.

One important aspect to pay particular attention to is the test menu; many reference laboratory representatives will present you with a test menu that may exceed your needs. There are many urine drug tests available, some of which you may not wish to include in your testing menu.

Insist on creating a custom test profile, choosing the tests you desire to utilize when testing your patients, as well as the type of testing performed. There currently are no consistent regulations or requirements regarding supplemental or confirmation testing for urine drug screening, so insure that your reference laboratory understands that you will determine what specimens need additional testing and what testing is to be performed.

For offices with a CLIA Certificate of Waiver who are using rapid drug screening cups only, supplemental testing is recommended by all rapid cup manufacturers and
represents good practice. Supplemental testing by enzyme immunoassay methodology is the standard testing following rapid cup screening. Insure that your reference laboratory allows you to determine what test results if any will be referred for additional/confirmation testing by GC/MS or LC/MS. A specimen with expected results consistent with the patients prescribed medications does not require confirmation.

The decision to order confirmation testing should be at the discretion of the physician managing the patient's treatment, not the reference laboratory. Be aware of test panels that are automatically reflexed to confirmation testing. In many cases all tests in the panel, including negative tests, are reflexed to confirmatory testing by reference laboratories.

For offices with a CLIA Certificate of Compliance performing enzyme immunoassay
methods with an automated chemistry analyzer and reporting qualitative test results, samples should be submitted for additional testing. At the risk of sounding redundant, choose a reference laboratory that allows you to customize your supplemental test menu and establish a reflex to confirmation protocol that best serves your patient's and practice.

For offices with a CLIA Certificate of Compliance performing enzyme immunoassay methods with an automated chemistry analyzer and reporting quantitative test results the decision to confirm any test result should be at the discretion of the physician. Find a reference laboratory that will provide confirmation only by GC/MS or LC/MS without repeating the testing your laboratory has already performed to eliminate the potential for duplicate billing.

Choosing a reference laboratory will require effort and may lead to some potential frustrations, but once the process is over and a working relationship with your reference laboratory is established the benefits will be worth all of energy required to make it happen.

Best of luck in your adventure to choose a reference laboratory to meet all of the needs of your patient's and practice.