Wiki PRN and LTU/current use of opioid

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shadowshay

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The coders are supposed to code LTU/current use of opioids when documented in the medication list according to the facility. However, the other day, management mentioned that PRN medications are not to be coded according to the coding guidelines. I mentioned that opiate medications are always prescribed PRN with 0 refills now since the whole issue of over prescribing. Even with cancer patients, pain management, etc. He said if I can find a coding guideline or other resource that overrides this, then I can send that. Has anybody seen anything that is opioid related regarding coding these as PRN medications?
 
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I have not seen any guidance specific to this, but this is typically an area where each facility or practice will create their own internal guidelines. I would agree with your management's interpretation in this case. Assignment of a code depends on the physician's statement that the condition exists. If you have only a PRN prescription on the record and no mention by the physician that the patient is actually currently using that medication, then I don't believe you would have documentation to support that code. In any case, you should follow your employer's instructions on this as they're the ones who are ultimately responsible for their claims.
 
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Please read below from 3M ICD10-CM coding handbook:
Codes from category Z79 are assigned to indicate a patient's continuous use of a prescribed drug for an extended period. For example, codes from category Z79 are assigned for long-term use of medication:

As a prophylactic measure (e.g., to prevent deep vein thrombosis)
As treatment of a chronic condition (e.g., arthritis)
For a disease requiring a lengthy course of treatment (e.g., cancer)

A code from category Z79 is appropriately assigned when the patient is currently receiving long-term anticoagulant therapy (Z79.01), antithrombotics/antiplatelets (Z79.02), nonsteroidal anti-inflammatories (Z79.1), antibiotic therapy (Z79.2), hormonal contraceptives (Z79.3), insulin (Z79.4), steroids (Z79.51-Z79.52), immunomodulators and immunosuppressants (Z79.60-Z79.69) or other long-term drug therapy (Z79.81-Z79.899). Subcategory Z79.8 includes long-term use of selective estrogen receptor modulators (Z79.810), aromatase inhibitors (Z79.811), other agents affecting estrogen receptors and estrogen levels (Z79.818), aspirin (Z79.82), bisphosphonates (Z79.83), oral hypoglycemic drugs (Z79.84), injectable non-insulin antidiabetic drugs (Z79.85), hormone replacement therapy (Z79.890), opiate analgesic (Z79.891), and other long-term drug therapy (Z79.899). An additional code is assigned for the condition for which the medication is prescribed.

Note that coding guidelines do not provide a definition or time frame for long-term drug therapy. If a patient receives a drug on a regular basis and has multiple refills available for a prescription, it is appropriate to document long-term drug use. Documentation of long-term drug use is at the discretion of the health care provider.

Do not assign a code from category Z79 when the medication is prescribed to treat an acute illness or injury and is being given for a brief period of time (e.g., antibiotics to treat bronchitis). Codes from category Z79 are also not used when medications are given for detoxification or maintenance programs used to prevent withdrawal symptoms in patients with drug dependence. For example, long-term use of methadone for pain management is coded with Z79.891, Long term (current) use of opiate analgesic, but the use of methadone in a maintenance program to prevent withdrawal symptoms is coded using the drug dependence code (F11.2-).
 
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Also from coding clinic 1st quarter, 2021 pg 12-13
Question:
A patient diagnosed with asthma is currently on prescribed inhaled albuterol, "as needed" for control of symptoms. Since the medication is prescribed for long-term treatment of asthma, would it be appropriate to assign a code from category Z79, Long-term (current) drug therapy, even though the medication is taken pro re nata (PRN) to control symptoms of asthma?

Answer:
Medications that are prescribed on an as needed (PRN) basis would not be assigned codes from category Z79, Long-term (current) drug therapy. For example, rescue medications used to relieve asthma symptoms are not classified as long-term drug therapy.
 
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Thank you all for your response. These are patients that do have chronic conditions that are being treated with an opioid. But, ever since the meeting, I'm getting feedback from coders when I ding them for missing current use of opioid that because the medication list has PRN, they don't need to code it. I think that maybe I need to go back with the manager and discuss again from that point of view since the hospital is wanting these for reporting purposes. With the opioid crisis, it leaves the providers no choice but to subscribe as PRN with 0 refills. Maybe this is something that we could get the AHA to look at and add to the ICD-10-CM guidelines for any prescriptions that are commonly prescribed in this way. Again, thank you for your responses!
 
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nickelclaw said:
Also from coding clinic 1st quarter, 2021 pg 12-13
Question:
A patient diagnosed with asthma is currently on prescribed inhaled albuterol, "as needed" for control of symptoms. Since the medication is prescribed for long-term treatment of asthma, would it be appropriate to assign a code from category Z79, Long-term (current) drug therapy, even though the medication is taken pro re nata (PRN) to control symptoms of asthma?

Answer:
Medications that are prescribed on an as needed (PRN) basis would not be assigned codes from category Z79, Long-term (current) drug therapy. For example, rescue medications used to relieve asthma symptoms are not classified as long-term drug therapy.
Click to expand...
Yes, saw that and agree with the case scenario.
 
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nickelclaw said:
Please read below from 3M ICD10-CM coding handbook:
Codes from category Z79 are assigned to indicate a patient's continuous use of a prescribed drug for an extended period. For example, codes from category Z79 are assigned for long-term use of medication:

As a prophylactic measure (e.g., to prevent deep vein thrombosis)
As treatment of a chronic condition (e.g., arthritis)
For a disease requiring a lengthy course of treatment (e.g., cancer)

A code from category Z79 is appropriately assigned when the patient is currently receiving long-term anticoagulant therapy (Z79.01), antithrombotics/antiplatelets (Z79.02), nonsteroidal anti-inflammatories (Z79.1), antibiotic therapy (Z79.2), hormonal contraceptives (Z79.3), insulin (Z79.4), steroids (Z79.51-Z79.52), immunomodulators and immunosuppressants (Z79.60-Z79.69) or other long-term drug therapy (Z79.81-Z79.899). Subcategory Z79.8 includes long-term use of selective estrogen receptor modulators (Z79.810), aromatase inhibitors (Z79.811), other agents affecting estrogen receptors and estrogen levels (Z79.818), aspirin (Z79.82), bisphosphonates (Z79.83), oral hypoglycemic drugs (Z79.84), injectable non-insulin antidiabetic drugs (Z79.85), hormone replacement therapy (Z79.890), opiate analgesic (Z79.891), and other long-term drug therapy (Z79.899). An additional code is assigned for the condition for which the medication is prescribed.

Note that coding guidelines do not provide a definition or time frame for long-term drug therapy. If a patient receives a drug on a regular basis and has multiple refills available for a prescription, it is appropriate to document long-term drug use. Documentation of long-term drug use is at the discretion of the health care provider.

Do not assign a code from category Z79 when the medication is prescribed to treat an acute illness or injury and is being given for a brief period of time (e.g., antibiotics to treat bronchitis). Codes from category Z79 are also not used when medications are given for detoxification or maintenance programs used to prevent withdrawal symptoms in patients with drug dependence. For example, long-term use of methadone for pain management is coded with Z79.891, Long term (current) use of opiate analgesic, but the use of methadone in a maintenance program to prevent withdrawal symptoms is coded using the drug dependence code (F11.2-).
Click to expand...
It's the 'has multiple refills available' that is maybe needing a review for medications that are clinically prescribed as PRN 0 refills.
 
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