New Rules require Ohio Physicians to Report ICD-10 Codes on Controlled Substance Prescriptions

by | Published on Aug 28, 2017 | Medical Coding

Substance Prescriptions
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ICD-10 coding is complex and many physician practices make use of medical coding services to report the right diagnostic codes for various medical conditions. Ohio physicians will now have to report ICD-10 codes on prescriptions for controlled substances.

On July 28, 2017, associations representing physicians and hospitals reached an agreement with the Governor’s office and the State Medical Board of Ohio, under which prescribers must begin reporting ICD-10 codes for opiate prescriptions for acute pain to OARRS, Ohio’s prescription drug monitoring program, as soon as the proposed rules are finalized. The proposed rules of the State of Ohio Board of Pharmacy aim to include conditions such as attention deficit disorder, low testosterone, narcolepsy, and seizure disorders. The National Law Review reports that new rules were proposed following the announcement of new opiate prescribing standards for acute pain by Ohio Governor John Kasich and the executive directors of Ohio’s health care licensing agencies on March 30, 2017.

Medical coding outsourcing can help Ohio physicians and pharmacies report the right ICD-10 codes for acute pain, attention deficit disorder, low testosterone, narcolepsy, and seizure disorders on controlled substance prescriptions. Here are the ICD-10 diagnostic codes for these medical conditions:

  • Acute and chronic pain: Once diagnosed, mild to moderate pain is treated with acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). If these options are not sufficient, medications that target separate pathways simultaneously, such as an acetaminophen/opioid combination, are considered reasonable alternatives. Severe acute pain is typically treated with potent opioids.
    ICD-10 codes for acute or chronic pain come under the category G89, Pain, not else where classified. The subcategories further classified by type, temporal parameter, and causation:
    G89.0 Central pain syndrome
    G89.11 Acute pain due to trauma
    G89.12 Acute post‐thoracotomy pain
    G89.18 Other acute postprocedural pain
    G89.21 Chronic pain due to trauma
    G89.22 Chronic post‐thoracotomy pain
    G89.28 Other chronic postprocedural pain
    G89.29 Other chronic pain
    G89.3 Neoplasm related pain (acute) (chronic)
    G89.4 Chronic pain syndrome
    Codes in category G89 are used if the documentation indicates that the pain is acute, chronic, or neoplasm-related and may be used in conjunction with other codes to provide more detail about acute or chronic pain and neoplasm-related pain. Points to note:

    • If the cause of the pain is known, the code assigned should be that for the underlying diagnosis, not the pain code
    • If the purpose of the encounter is to manage the pain rather than the underlying condition, the pain code should be assigned and sequenced first.
  • Attention deficit disorder: Many stimulant ADHD medications such as dextroamphetamine-amphetamine (Adderall, Adderall XR), lisdexamfetamine (Vyvanse), and methylphenidate (Ritalin) are controlled substances that fall into the Schedule II category. The ICD-10 codes for this condition are as follows:
    F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
    F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type
    F90.2 Attention-deficit hyperactivity disorder, combined type
    F90.8 Attention-deficit hyperactivity disorder, other type
    F90.9 Attention-deficit hyperactivity disorder, unspecified type
    Conditions included in the F90.- category are indexed in the ICD-10 code book under “disorders,” then “attention-deficit with or without hyperactivity.” Points to note:

    • When reported as a principal diagnosis, a code from category F90.- groups to MS-DRG 886 (behavioral and developmental disorders).
    • These codes help convey severity of illness (SOI) and risk of mortality (ROM) of the patient.
    • Category F90.- codes may be used regardless of the patient’s age.
  • Low testosterone: The body produces testosterone naturally, though testosterone and other anabolic steroids are classified as controlled substances under the Anabolic Steroids Control Act, and DEPO-Testosterone Injection has been assigned to Schedule III.
    The ICD-10 codes for testicular dysfunction are as follows:
    E29 – Testicular dysfunction
    E29.0 – Testicular hyperfunction
    E29.1 – Testicular hypofunction
    E29.8 – Other testicular dysfunction
    E29.9 – Testicular dysfunction, unspecified
  • Narcolepsy:
    G47.419 – Narcolepsy without cataplexy
    Narcolepsy is characterized by recurrent episodes of excessive sleepiness in the daytime and lapses in consciousness (microsomnias) that may be associated with automatic behaviors and amnesia. Cataplexy, sleep paralysis, and hypnagogic hallucinations commonly accompany narcolepsy. The pathophysiology of this disorder includes sleep-onset rapid eye movement (rem) sleep, which normally follows stages3 or 4sleep.
    Most narcolepsy drugs are FDA-controlled substances, Schedules II, III or IV, and may be disconcerting to patients because of concern with addiction or abuse potential. For physicians, these drugs pose the greater burden of record keeping. For instance, Schedule II controlled substances such as dextroamphetamine, lisamphetamine, methamphetamine, and methylphenidate have high potential for abuse, and may lead to severe psychologic or physical dependence.
  • Seizures disorders:
    Seizures can take multiple forms, such as tonic, atonic, myoclonic, and atypical absence. FDA-approved drugs to treat epilepsy in recent times have often been controlled substances including Lyrica, Vimpat, and Fycompa. According to the new rules, the codes may have to be included when prescribing controlled substances to treat this condition:
    G40 Epilepsy
    G40.1 Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures (which can evolve to secondarily generalized seizures)
    G40.2 Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures (which can evolve to secondarily generalized seizures
    G40.3 Generalized idiopathic epilepsy and epileptic syndromes
    G40.4 Other generalized epilepsy and epileptic syndromes
    G40.5 Special epileptic syndromes
    G40.6 Grand mal seizures, unspecified (with or without petit mal)
    G40.7 Petit mal, unspecified, without grand mal seizures
    G40.8 Other epilepsy
    G40.9 Epilepsy, unspecified
    G41 Status epilepticus
    G41.0 grand mal status epilepticus
    G41.1 Petit mal status epilepticus
    G41.2 Complex partial status epilepticus
    G41.8 Other status epilepticus
    G41.9 Status epilepticus, unspecified
    R56 Convulsions, not elsewhere classified
    R56.0 Febrile convulsions (code here if simple)
    R56.8 Other and unspecified convulsions
    P90 Convulsions of newborn

According to a New York Times report, drug overdose deaths in 2016 are likely to have crossed 59,000, the largest annual increase ever recorded in the United States. Ohio has been taking proactive steps towards combating opioid addiction and overdose by shutting down “pill mills”, dealing with traffickers, and working with the medical community to adopt prescribing guidelines which ensure that patients get the right pain treatment without spiraling into addiction and overdose. The state’s online prescription drug monitoring program allows prescribers and pharmacists to quickly identify potential signs of addiction, such as multiple opiate prescriptions from different prescribers, and assist patients in getting help. This will help State Medical Board of Ohio understand what conditions are being treated using potentially addictive opiates, which will promote effective regulation and education of Ohio physicians. The aim is to make physicians understand that they can treat pain effectively with fewer opiate prescriptions.

The experienced teams in reliable medical coding companies can support these endeavors by helping physicians and pharmacists assign the right codes on prescriptions for controlled substances based on the clinical documentation.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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