Lab: Urine Drug Testing Open Public Meeting - June 10, 2020 - JE Part A

JOCELYN FERNANDEZ:
Good afternoon, and welcome members of the public to the open meeting for the proposed LCD Lab Urine Drug testing: LCD number a DL38625 for jurisdiction E and DL38639 for jurisdiction F.

The meeting will be recorded. The audio recording and written transcript will be posted on our website following today's meeting.

All lines are currently being muted by our system and will remain muted throughout the meeting. I will now turn the meeting over to Dr. Larry Clark for an overview of the Proposed LCD.

DR. LAWRENCE CLARK:
Thanks, Jocelyn and thanks to the 30 some of you that were good enough to come back for yet one more laboratory policy in this series. This is not a molecular pathology LCD and consequently does not have the MolDX designation. However, it is a collaboratively developed policy, and, as Jocelyn just said, it is dedicated to the appropriate usage of urine drug testing.

The LCD DL38625 concerns the coverage of testing for the use of urine drug testing, and divides into four broad categories, the indications for testing, the frequency of the testing, the choice of the testing modality simply put presumptive versus definitive testing, and the use of definitive testing and the number of analytes.

Unfortunately, urine drug testing is in some way, still controversial, and, unfortunately, frequency of utilization and inappropriate utilization remain issues. This policy is strongly built around policy bibliography, reference eight, which is the SAMSA guidelines, which were initially developed in 2012 and later revised, but are an excellent and essentially national approach to the, the indications for testing and the four bullet points that I highlighted. Generally, when people look at the uses of urine drug testing indications, you're treating three major clinical circumstances.

The first of them is substance abuse or substance dependency treatment.

The second is an acute situation where a patient develops unexpected, acute signs and symptoms of potentially relating from unknown or unrecorded pharmacologic substance ingestion.

And the third is monitoring and checking appropriate compliance with chronic long-term controlled substance therapy.

The policy is clearly divided into these subsections, with appropriate guidelines towards the frequency of utilization, and the types of tests that should be performed, and yet, at the same time, has flexibility, because it's recognized that there can be significant clinical differences in the presenting circumstance.

I'm disappointed. I had hoped that Dr. Pubillones, one of my Noridian colleagues as a psychiatrist with experience, personal experience in this field of medicine would have joined me had there been any presentations for us to discuss, or ask questions about, but seeing that, we have none. I think the best thing that I can do, with my time and your time, is to return it to you.

I'm going to just remind you that in approximately one hour at 3:00 PM CST, 4 PM, EST

Can I get that right? Please Jocelyn, let me make sure I'm right, and that, I think it's 2:00 PM CST and 3:00 PM EST. We are going to have an open meeting on a collaborative policy Percutaneous Vertebral Augmentation for Vertebral Compression Fractures. That's DL34228 and then one week today, at 4:00 PM CST we will be having an Implanted Continuous Glucose Monitoring open meeting and that is Policy DL38657. So, again, I apologize that we did not have any laboratory presenters. The policy question today is DL38625, then Jocelyn will go over the details of the comment period and how you may submit written comments commentary to us, and on behalf of all of us at Noridian, thank you for being on. Jocelyn.

JOCELYN FERNANDEZ:
OK, let me just make a correction for the Percutaneous Vertebral Augmentation Open Meeting.

That will begin.

It will begin at 3:00 PM Central Time.

DR. LAWRENCE CLARK:
Thank You, OK.

JOCELYN FERNANDEZ:
OK, so moving on, since we have no registered commenters, we'll go on to closing and next steps.

In closing, we would like to communicate the next steps in the policy development process.

The comment period for the Proposed LCD will remain open until July 12, 2020. As noted earlier, all comments to be considered by our Medical Directors for the Proposed LCD must be submitted in writing. Written comments can be emailed to policy draft at policydraft@Noridian.com, or mail to the address on your screen. Comment information for our proposed LCDs are located on our website at noridianmedicare.com, upon review of the comments our Medical directors will either finalize or retire the proposed LCD. Please monitor our website or register for listserv notifications to be informed of actions taken on our proposed LCD.

Doctor Clark, any final comments?

DR. LAWRENCE CLARK:
Yeah. Thank you, everybody for coming.

JOCELYN FERNANDEZ:
Thank you, everyone, for attending. This concludes our meeting for today. Enjoy the rest of your day.