Wiki Question for opioid coding

[greenk]

I'm so confused. We are being told by Humana to use F11.20 opioid dependence, uncomplicated for our pain management patients that are on long term opioids. They said if the patient is dependent on opioids for ADLs then that code is appropriate. Everything I am seeing does not match with that information. Anyone have any knowledge on this?

 

[thomas7331]

I agree with you - what they are telling you is clearly incorrect coding per the ICD-10 guidelines and in my opinion highly inappropriate.

I would not code this way unless they have put it clearly in writing in their policies that they require you to do so in order to obtain payment. If that is the case, I would recommend retaining a hard copy of their policy in your files in case you were ever cited an error for putting it on the claim. I think I'd also want to take steps to ensure that the use of this code in this situation does not go out to any other payer.

 

[greenk]

I agree with you - what they are telling you is clearly incorrect coding per the ICD-10 guidelines and in my opinion highly inappropriate.

I would not code this way unless they have put it clearly in writing in their policies that they require you to do so in order to obtain payment. If that is the case, I would recommend retaining a hard copy of their policy in your files in case you were ever cited an error for putting it on the claim. I think I'd also want to take steps to ensure that the use of this code in this situation does not go out to any other payer.

Thank you for your help!! I am waiting to hear back from another contact there.