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Frank Mesaros, MPA, MT(ASCP), CPC, is CEO of Trusent Solutions, LLC, a management consulting firm specializing in the laboratory industry. /* ----------------------------------------- */ www.anthem.com/painmanagement/documents/Urine_Drug_Screening.pdf. There are additional tests that may be performed in conjunction with the creatinine, SG, and pH specimen validity tests. The pH level determines the acidity or alkalinity of the sample. Thermo Fisher Scientific provides Specimen Validity Tests for creatinine, specific gravity, oxidizing agents (e.g. The product . Creatinine levels in the urine are a good indicator of this phenomena.2,3 The higher the creatinine, the more concentrated the urine and vice versa. The Internet offers a wealth of information regarding techniques to "pass" a standard drug test. Tech & Innovation in Healthcare eNewsletter, www.anthem.com/painmanagement/documents/Urine_Drug_Screening.pdf, http://buprenorphine.samhsa.gov/tip43_curriculum.pdf, https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0513_coveragepositioncriteria_drug_test.pdf, www.afspa.org/home/pdfs/FEHBP-Urine-Drug-Testing-Coverage.pdf, www.medicare.fcso.com/Fee_lookup/LCDDisplay.asp?id=DL35654, www.mhbp.com/web/groups/public/@cvty_mailhandlers_mhbp/documents/document/c075890.pdf, www.practicalpainmanagement.com/resources/diagnostic-tests/specimen-validity-testing, Capture the Complete Clinical Picture With Precision, Applying RVUs to Pharmacists Patient Care Services, Report ABA Therapy Services With Confidence, Be an Attractive Candidate for a Hospital Coding Position, Build Revenue with Surgical Chart Auditing, Ask the Right Questions Before Outsourcing Your Billing. It measures the concentration of dissolved particles in the sample. Collect 2 mL urine in a preservative-free plastic container. K.E. - 2FMB19H from Alamy's library of millions of high resolution stock photos, illustrations and vectors. November 15, 2014: /* ----------------------------------------- */, UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, Specimen Collection Procedures: Hematopathology, Specimen Collection Procedures: Microbiology, Surgical Pathology Shipping Instructions: Muscle Biopsies, Surgical Pathology Shipping Instructions: Nerve Biopsies, Surgical Pathology Shipping Instructions: Renal Biopsy, UF Health Shands Children's Sun & Moon. Phone:352.265.9900 Mandatory Guidelines for Federal Workplace Drug Testing Programs: Current status and future considerations, Forensic Science International 174 (2-3): 111-119, 2008. Search Key terminology Specimen validity tests determine whether a urine specimen has been adulterated, diluted, or substituted to obtain a negative result, or is invalid. Adherence can be masked by dilute urine, quantity ingested, time since last dose, or the laboratorys assay detection levels. Negative results in a dilute urine specimen may lead to misinterpretation of results. A deviation from the normal parameters is evidence of dilution or adulteration. Search Product Overview Documents Showing 1 of 1 Save to list We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Creatinine and specific gravity are two ways to check for dilution and flushing, which are the most common mechanisms used in an attempt to circumvent drug testing. Cigna coverage policy 0512 regarding drug testing indicates routine tests to confirm specimen integrity are not covered because they are not considered medically necessary. Drug concentrations in urine can be influenced by dilution (drinking large amounts of water) or dehydration. /* Content Template: Template for Tests - end */ /* ----------------------------------------- */ . Weather Today Weather Hourly 14 Day Forecast Yesterday/Past Weather Climate (Averages) Currently: 50 F. There are basically three categories of such products: a) dilution and cleansing products, b) urine additives, and c) synthetic urine substitutes. In both the clinical setting and for federal workplace drug testing, the use of these methods to mask controlled substances in urine samples presents an ongoing challenge to drug screening. To counter these efforts, SAMHSA mandates the testing of creatinine, specific gravity (SG), and pH on all urine samples in order to verify specimen validity.. A test for general oxidants or specific oxidants may be conducted to provide further information regarding the validity of a urine sample. Urine is the most commonly used specimen for drugs of abuse testing. Increased SG values could be due to dehydration, renal dysfunction, and other medical factors including increased antidiuretic hormone secretion, which can be due to stress, trauma, and some drugs.. An adulterated urine specimen contains a substance that is not normally found in urine, or that normally is found, but is in abnormal concentrations. Passing clouds. DST Changes. As noted, an estimated 23 million Americans have engaged in illicit drug use in the past month alone. The overwhelming majority of these individuals wish to conceal their use from others at all cost. The DOT instituted mandatory SVT for its drug testing programs in August 2008. A detailed medication history including prescription, nonprescription and herbal medications and proper knowledge of medications that cross-react with urine drug screens are essential for assessing cross reactivity that may affect results. Testing for adulterants assures validation of negative results and confirms sample validity. Urine Specimen Validity Testing specimen dilution, substitution or adulteration Recovery Management programs are justifiably concerned about participants that may be attempting to mask drug/alcohol use and/or to compromise the drug monitoring program by intentional acts of specimen dilution, substitution, or adulteration. Tellioglu, Tahir, The Use of Urine Drug Testing To Monitor Patients Receiving Chronic Opioid Therapy for Persistent Pain Conditions, Medicine and Health Rhode Island 91 (9), pages 279-80, 282. While specimen validity testing is not standardized with the use of in-office point-of-care drug testing, laboratories that specialize in urine drug testing often have established specimen validity testing protocols and toxicologists in place in order to assist with report interpretation. For the practitioner who has concerns regarding drug abuse or non-compliance, these specimen validity tests can also provide scientific results that, when coupled with other indicators (eg, incorrect pill counts, suspicious behaviors, clinical symptoms), may assist with the initiation of a conversation regarding potential drug abuse, mismanagement of medications, or diversion of prescribed drugs. Dasgupta, A. Focus on Screens looks at interpreting urine drug assay results. Samples with a creatinine <2.0 mg/dL and an SG >1.0010 and <1.0200 or with a pH >9.0 but <11.0 are reported as invalid. In addition to performing specimen validity testing, collectors should also check temperature and visually inspect the specimen for color and viscosity to assess possibility of adulteration. Copyright 2022, AAPC Creatinine, Urine specimen validity. Combat the use of additives and adulterants to mask controlled substances in urine samples with Thermo Scientific DRI Creatinine-Detect Specimen Validity Tests. The absence of Creatinine (<5 mg/dl) is indicative of a specimen not consistent with human urine. Urine samples are adulterated in order to obtain a false negative result by the patient or participant. It digs deeper into the urine test results and ensures that the urine sample was that of a human without any tampering. Synthetic urine products can be submitted when urine specimen collection is not observed; however, more commonly, water or saline solution is substituted. (Bush 2008) Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (TAP 32), chapter 4, page 43. Illicit drug use is defined as the use of marijuana, cocaine, heroin, hallucinogens, inhalants, or the non-medical use of prescription psychotherapeutics (prescription pain relievers, tranquilizers, stimulants, and sedatives). A urine sample is classified as invalid when the creatinine and SG results are discrepant, or do not match, or when the pH is much lower or higher than typically expected. Privacy Policy | Terms & Conditions | Contact Us. www.practicalpainmanagement.com/resources/diagnostic-tests/specimen-validity-testing. Despite all the benefits and ease in testing urine specimens, urine samples are extremely susceptible to tampering1, making it tempting for participants to either use adulterants or dilute their urine. Urine pH values typically fall between 4.5 and 9.0. Abuse Testing, First Coast Service Options. He is a member of the Harrisburg, Pa., local chapter. Treating physicians typically order specimen validity testing to make patient-specific therapeutic decisions, including those related to medication compliance and illicit drug use. Cook JD, Strauss KA, Caplan YH, Lodico CP, Bush DM. Specimen validity testing provides evidence that, when taken into consideration with other indicators (e.g., incorrect pill counts, suspicious behaviors, clinical symptoms), may assist the medical management of the patient, including the initiation of a conversation regarding potential drug abuse, mismanagement of medications, or diversion of prescribed drugs. Dasgupta A. Fortunately, urine drug testing is a well-established and readily available clinical tool to objectively assess an individuals illicit drug use behaviors. Earn CEUs and the respect of your peers. Specimen validity testing (SVT) is employed to validate the integrity of a urine drug test result. Specimen Validity Testing can check for the following in the urine specimen: pH Creatinine Specific Gravity Oxidizing adulterant Center for Substance Abuse Treatment, Medication-Assisted Treatment for Opioid Trusent provides revenue stream integrity services to regional laboratories, hospital based laboratories, and physician office based laboratories. Together we care for our patients and our communities. Specimen validity testing While it is the most common drug testing method, urine testing is not foolproof. Jacksonville: 904.427.0865 Low creatinine levels can be a result of drinking more water than usual or attempting to dilute a specimen. Volume II, NADCP, 2015. nitrites) and pH. Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention. Gainesville, FL 32608, Hours: Monday - Friday:8 a.m. - 5 p.m. EST. Adult Drug Court Best Practice Standards. An adulterated specimen is a urine specimen containing a substance that is not a normal constituent of urine or a specimen containing an endogenous substance not present at a normal physiological concentration.. A federal employee health benefit plan for mail handlers (Mail Handlers Benefit Plan) on urine drug testing specifically indicates CPT codes 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; and 82570 Creatinine; other source as additional tests that may be appropriate to verify a urine sample was not adulterated when specifically ordered by the authorized requesting provider. drug courts) or for compliance.1 In general, human urine reflects drugs consumed within the past several days depending on drug use. Some common oxidants used to attempt to alter urine drug test results are bleach, nitrate, chromate, iodate, and peroxidase. Specimen validity testing (SVT) is performed on a urine drug screen specimen to detect substitution, adulteration, or dilution. Coverage Varies, but Is a No for Medicare Creatinine is found naturally in the urine. SAMHSA has defined the requirements that laboratories must meet to conduct SVT for federal employee testing. Urine pH: the effects of time and temperature after collection. a diagnostic laboratory test must be ordered by the treating physician and the test results must be used in the management of the beneficiarys specific medical problem. This is primarily because urine is readily available in large quantities and contains high concentrations of parent drugs and metabolites. Liquid and ready-to-use, these tests can be performed on a variety of general chemistry analyzers. Hours: Monday - Friday:8 a.m. - 5 p.m. EST It provides clinicians with critical information about the accuracy and reliability of drug test results, and that the specimen submitted is a valid human urine specimen. In addition to our extensive Syva drugs-of-abuse testing menu, Siemens Healthineers offers five specimen validity tests to help you determine if you are testing a valid urine sample. The Effects of Adulterants and Selected Ingested Compounds on Drugs-of-Abuse Testing in Urine. American Journal of Clinical Pathology., U.S. National Library of Medicine, Sept. 2007. Creatinine Adjustment, also referred to as Creatinine Normalization, is used to normalize the creatinine concentration of urine to an expected average creatinine concentration. First Coast Service Options, Inc., Controlled Substance Monitoring and Drugs of Low Creatinine and specific gravity levels may indicate dilute urine. Home Test Menu Test Directory: C Creatinine, Urine specimen validity. Testing participant samples every time using multiple Specimen Validity Tests allows you to create a historical map of the expected normal results for a particular participant. Coventry Health Care, Urine Drug Testing Coverage, American Foreign Service Protective Association: www.afspa.org/home/pdfs/FEHBP-Urine-Drug-Testing-Coverage.pdf. Bush, Donna M., The U.S. Sort By: Table 2 shows a report of an invalid sample. Check the relevant coverage policies to determine whether this testing is covered and what documentation to maintain. According to data released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2012, nearly 23 million Americans aged 12 years or older participated in illicit drug use in the past month. That accounts for 8.7% of the population, making it a major public health problem in the United States., Urine drug screening is a clinical tool that can enhance workplace safety, monitor patients medication compliance, and detect drug (illicit and prescription) abuse as well as prescription medication diversion. A creatinine level outside of these values may result from excessive fluid intake, renal failure, diet, or a number of other medical conditions or factors. [a] laboratory test is a covered benefit only if the test result is utilized for management of the beneficiarys specific medical problem. A substituted specimen is a urine specimen with creatinine and SG values that are so diminished or so divergent that they are not consistent with normal human urine., Samples with pH <3.0 or >11.0 are reported as adulterated. It is hence, an accepted way of testing for specimen validity when monitoring for abused drugs whether within the workplace, criminal justice system (e.g. Although some laboratory requisitions allow the ordering physician to designate specimen validity testing (e.g., creatinine, oxidant, pH, specific gravity) to ensure that a patient specimen has not been adulterated, the results of this testing are not used in the management of the beneficiary's medical problem. After you've learned about median download and upload speeds from Duisburg over the last year, visit the list below to see mobile and . . 2013;13(5). Samples with a creatinine <2.0 mg/dL and an SG <1.0010 and >1.0200 are reported as substituted. Download this stock image: Duisburg, North Rhine-Westphalia, Germany - Test facility for hydrogen refueling, ZBT Center for Fuel Cell Technology Duisburg, one of the leading European research institutions for fuel cells, hydrogen technologies and energy storage. Past Weather in Duisburg, North Rhine-Westphalia, Germany Yesterday and Last 2 Weeks. Specimen validity tests (SVT) are methods used on a urine drug screen specimen to detect for substitution, adulteration, or dilution. Normalization of Urinary Drug Concentrations with Specific Gravity and Creatinine. Journal of Analytical Toxicology., U.S. National Library of Medicine. https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0513_coveragepositioncriteria_drug_test.pdf. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012. (First Coast Service Options, Inc., 2014) The temperature of a sample is also an important characteristic to note. Create Account. DRI Creatinine-Detect Specimen Validity Test, Chromatography Columns, Resins, & Spin Filters, Spectroscopy, Elemental & Isotope Analysis, Preclinical to Companion Diagnostic Development, Blood, Hematology and Coagulation Testing Products, DRI Creatinine-Detect Assay Specimen Validity Test, Associated calibrators and controls offered in convenient sizes, Complete and automated way to test for sample integrity and adulteration. Table 1 shows a report reflecting a dilute sample. 4800 SW 35thDrive Cigna, Cigna Medical Coverage Policy Drug Testing, October 15, 2015: Liquid and ready-to-use, these tests can be performed on a variety of general chemistry analyzers. http://buprenorphine.samhsa.gov/tip43_curriculum.pdf In addition to the personal toll, the societal burden may be significant. The fact that a sample is dilute (for whatever reason) may impact the ability to detect any drugs present in the sample. University of Florida Health Pathology Laboratories This specimen validity urine test performs several measurements to help verify that a specimen has been . Kenneth L. Kirsh, Christo, P.J., Heit, H., Steffel, K., and Passik, S.D., Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications, Journal of Opioid Management, 11 (1): 53-59. Concerns of drug abuse and noncompliance are considerations pain management physicians routinely assess. CPT Code(s): 82570. Weather. Palmetto GBA, Specimen Validity Testing (M00024), MolDX. A urine sample is classified as invalid when the creatinine and SG results are discrepant, or do not match, or when the pH is much lower or higher than typically expected. The Centers for Medicare & Medicaid Services (CMS), NCCI Policy Manual for Medicare Services, chapter 10, section E. Moeller, Lee, K.C., and Kissack, J.C., Urine Drug Screening: Practical Guide for Clinicians. Mayo Clinic Proceedings 83 (1): 66-76. Clinical Chemistry, Drug and Toxicology Testing, Preclinical to Companion Diagnostic Development, Drug Monitoring, Quality Controls and Instrumentation Product Catalog, Specimen Validity Testing SmartNotes Brochure, Complete Automated DAT Process Brochure (Indiko Plus), CEDIA and DRI Drugs of Abuse Immunoassay Brochure. Thermo Scientific DRI pH-Detect Specimen Validity Test, Package Insert. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. SMA 12-4668. At the end, testing urine samples for specimen validity ensures for a more effective drug monitoring program. Diluting the urine sample to the point where the targeted drug is below the cutoff concentration is a way to get a negative result. Taken together, creatinine, SG, and pH are used to validate urine samples. Ko M, Merritt P, Dawson E. Specimen Validity Testing. This presents a significant barrier for those who have a vested interest in the physical health and emotional well being of the individual. nitrites) and pH. Advances in Pharmacologic Pain Management of Juvenile Idiopathic Arthritis, Editor's Memo: Interpreting Indications For Electromagnetic Therapy, Integrative Treatment Approaches for Juvenile Idiopathic Arthritis, Traumatic Brain Injury: Treatment of Post-traumatic Headaches. Oxidants can cause decreased levels or negative results for certain drugs, either by masking the drugs presence or by actually destroying the drug in the sample. Typically, this may be water or water with salt in it and is identified by extreme creatinine and specific gravity results. This may have the unintentional effect of masking the presence of some underlying medical conditions by providing misleading urine drug test results. A dilute specimen is a urine specimen with creatinine and SG values that are lower than expected for human urine. Dilution may be the result of many factors including ingestion of large amounts of water, a medical condition or medication, or adding water/liquid to a sample. These Internet sites provide everything from general advice to specific products designed to avoid drug detection in the users urine. Additional Information: UFHPL Epic order code: LAB384. Pract Pain Manag. (Substance Abuse and Mental Health Services Administration) Specimen validity tests (SVT) are methods used on a urine drug screen specimen to detect for substitution, adulteration, or dilution. All three of these important criteria must fall within the range of normal human urine for a urine sample to be considered valid. The temperature of a sample should be taken within 4 minutes of collection and should fall between 90 F and 100 F. A temperature that falls outside of this range suggests tampering with that sample. Adulterants work by interfering with immunoassay and/or confirmatory assay function, or they convert the target drug into compounds not detected by the test. Pesce A, West C, City KG, Strickland. (Cigna 2015) Because the phrase routine tests is used, you can argue that although routine integrity testing is not covered, integrity testing when specifically requested may be covered. The effects of adulterants and selected ingested compounds on drugs-of-abuse testing in urine. Hospital, College of Public Health & Health Professions, Clinical and Translational Science Institute, University of Florida Pathology Laboratories 4800 SW 35th Drive Gainesville, FL 32608 888.375.LABS or 352.265.9900. Palmetto Government Benefits Administrator states their position in policy M00024, consistent with the NCCI manual: In the absence of this validity testing, a patient may succeed in deceiving a physician through the submission of an adulterated urine specimen. Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the validity testing. In situations where individuals attempt to evade detection of certain drug use, urinary substitution techniques and devices can be sophisticated and difficult to detect. (Kirsh 2015) For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed. This information on internet performance in Duisburg, North Rhine-Westphalia, Germany is updated regularly based on Speedtest data from millions of consumer-initiated tests taken every day. /* Content Template: Template for Tests - start */ Creatinine is typically present between 20 and 400 mg/dL. Urine Evaluation and Report /* ----------------------------------------- */ Together we teach. You may know it as adulteration, specimen validity, or specimen integrity testing; regardless of terminology, Medicare does not cover it, but other insurance plans do. Because drug testing is associated with personal, occupational, and legal implications, pain specialists and primary care physicians must be confident in their abilities to interpret urine drug assay results in order to respond duly to optimize clinical outcomes. When assessing for medication adherence, there are two areas of critical concern: one is the detection of a non-prescribed drug, an unexpected metabolite, or illicit substance; the other is a false-negative result. Specimen Requirements: Collect 2 mL urine in a preservative-free plastic container. Interpretation of urine drug testing in pain patients. Creatinine: Creatinine is a byproduct of muscle metabolism that is normally excreted from the body in urine at a consistent level. Standridge JB, Adams SM, Zotos A. Urine drug screening: a valuable office procedure. Medical Necessity Thermo Fisher Scientific. CARES Alliance, Urine Drug Screening A Practical Guide for Clinicians, 2010: Contact us to speak with a sales representative. Similarly, Florida Medicare administrative contractor First Coast Service Options does not cover specimen validity testing including, but not limited to pH, specific gravity, oxidants, and creatinine. Doing so allows drug testing facilities to track participants and creates a powerful tool to help confront denial. June 1, 2013: It is produced by the breakdown of muscle tissue and cleared from the body via the kidneys. September 4, 2014. Although specimen validity testing is arguably medically necessary, routine use fits into Medicares definition. Samples with a creatinine >2.0 and <20 mg/dL and an SG >1.0010 and <1.0030 are reported as dilute. Specimen validity testing is the evaluation of the specimen to determine if it is consistent with normal human urine (creatinine values greater than 20 mg/dL). Clinical Drug Testing in Primary Care_. When abnormally large quantities of fluids are consumed, the urine becomes diluted and the creatinine levels are substantially reduced. Specimen validity testing SVT is defined as the evaluation of a specimen to determine if it is consistent with normal human urine. Coventry Health Care, an Aetna company, has a urine drug testing policy with the same coverage wording. Time Zone. Urine tests can appear in a report as adulterated, substituted, or dilute. Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Cone, E J, et al. Technical Assistance Publication (TAP) 32. Therefore, Palmetto GBA has determined that specimen validity testing is a statutorily excluded service. Thermo Fisher Scientific, Don't have an account ? 43 (Substance Abuse and Mental Health Services Administration): In 2004, significant revisions requiring specimen validity testing on federal employee donor urine specimens were included. Together we discover. Combat the use of additives and adulterants to mask controlled substances in urine samples with Thermo Scientific DRI Creatinine-Detect Specimen Validity Tests. Invalid Specimen Samples with a creatinine <2.0 mg/dL and an SG >1.0010 and <1.0200 or with a pH >9.0 but <11.0 are reported as invalid. Substance Abuse and Mental Health Services Administration_. September 2022. Categories of invalid samples are presented here. A positive result for oxidant activity should be considered when interpreting drug results. It is possible that urine specimen pH may be elevated up to 9.5 due to poor storage conditions such as elevated temperature. An extremely high or low pH can be an indication of tampering with a sample or adulteration. Specimen validity testing is an important part of every urine drug test. Decreased SG values may be due to excessive fluid intake, renal failure, diabetes insipidus, as well as a variety of other factors. Substance Abuse and Mental Health Services Administration. Together we create unstoppable momentum. Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Technical Assistance Publication Series TAP 32), chapter 5, pages 52-54. Time/General. Under the SAMHSA guidelines . (Moeller 2008) SG is a measurement of the density of a liquid compared to the density of water. (CARES Alliance 2010) Section 40.89(b), 49 CFR, June 25, 2008. Mancia Ko, Merritt, P., and Dawson, E., Specimen Validity Testing Focus on Screens looks at interpreting urine drug assay results. Practical Pain Management. Transport/Storage Temperature: Although some laboratory requisitions allow the ordering physician to designate specimen validity testing (e.g., creatinine, oxidant, pH, specific gravity) to ensure that a patient specimen has not been adulterated, the results of this testing are not used in the management of the beneficiarys medical problem. (Section 40.89(b) 2008) The U.S. Department of Health & Human Services drug testing standards were first published in 1988. Thermo Fisher Scientific provides Specimen Validity Tests for creatinine, specific gravity, oxidizing agents (e.g. Adulteration-Adding a substance to a specimen after it has been collected. Resources Specimen validity testing is mandatory for the Department of Transportation workplace drug and alcohol testing programs. HHS Publication No. This does not, however, take into account conditions where there may be medical value in the tests. Testing to confirm that a urine specimen is unadulterated is an internal control process that is not separately reportable. Understanding how to evaluate urine drug screens for adulterations, substitutions, and potential false results is complex, but vital to interpreting their results. (Ko 2013) In a document published on the Anthem Blue Cross Blue Shield website titled Urine Drug Screening A Practical Guide for Clinicians, laboratory tests are specifically specified, indicating contamination should be considered if test results for pH, specific gravity, urine creatinine, or urine nitrite levels are outside predetermined levels. With specimen validity testing, we can help ensure the integrity of the test by measuring pH, creatinine and specific gravity (when indicated) and testing for adulterants that may be added to the urine specimen. Addiction in Opioid Treatment Programs, Treatment Improvement Protocol (TIP) Series Mail Handlers Benefit Plan, FEHBP Urine Drug Testing. www.mhbp.com/web/groups/public/@cvty_mailhandlers_mhbp/documents/document/c075890.pdf
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