Pain Management Coding Alert

Published on Tue Sep 01, 2015 PDF

Question: We have patients who have instructions from their employers to get a 90-day drug supply to save the employer and the patient money. My surgeons want to help our patients in this regard, but we aren’t sure if there are restrictions against giving out more than a 30-day supply of pain killers, some of which are very strong, especially for our spine surgery patients and knee replacement patients. We researched and most of the drugs our doctors prescribe are in the “Schedule II” category. Can you advise?

New York Subscriber

Answer: Schedule II drugs have a high potential for abuse and are considered dangerous by the Drug Enforcement Agency, so they have certain restrictions under the law. Certain pain medications fall under the category of Schedule II drugs, including Dilaudid and fentanyl. The Federal government says in its DEA Diversion Control Program Practitioner’s Manual, “While some states and many insurance carriers limit the quantity of controlled substance dispensed to a 30-day supply, there are no specific federal limits to quantities of drugs dispensed via prescription.”

The Federal government does, however, limit oral orders for Schedule II drugs to emergency situations only—all other instances require a written prescription.

You should check with both the patient’s insurer and your state’s Drug Enforcement Agency to ensure that the 90-day supply meets their guidelines before you complete the prescription.