Wiki When to code drug dependence?!

[LindaKrarup]

I am looking for input on whether or not you can code drug dependence (opioid or other addictive drugs) if the drug is a prescribed medication for chronic pain or other reasons. Can it be considered drug dependence if a member is on chronic long-term drugs if they are prescribed? Thank you!

 

[1073358]

I recommend that you not try to make that determination. Your MD should be stating the DX in his/her note.

 

[LindaKrarup]

Guru,
Thank you for the response - if the provider lists "opioid dependence" as a diagnosis and it is a prescribed opiate, is it appropriate to code it as dependence? We are having some discussion about this here with my co-workers and we are trying to determine if it is appropriate to code dependence if the provider is stating this as a diagnosis and it is a prescribed medication.

 

[1073358]

I might be very off on this, but here is my opinion. The docs are trained to dx and treat people, as coder's we are not. You can be addicted to a px drug. Why they keep prescribing, is beyond me..but yes if it were me, I would code opiate dependence. Ultimately, its dr's call and he's responsible for it. If note says it is, than I would assume it is.

 

[kevbshields]

Linda:

Presently there are no code distinctions between therapeutic drug dependency (equivolent to insulin dependency in diabetics) versus dependency as a substance use disorder (equivolent to alcoholics).

Therefore, whether or not the dependency is based on therapeutic doses or outside that realm, I'd still code to dependency. However, since it is a prescribed medication, I'd follow that with a V58.69 for long-term use of other drug.

Some folks with chronic pain have little choice. Drug dependency is, unfortunately, a side effect of some pain management approaches.

I hope this helps you. I can find nothing in Coding Clinic to advise us.

 

[mitchellde]

Intersting analysis. I think this would be a great scenario to submit to coding clinics to see how they would respond.

 

[katrinabgood]

Along those lines: Is the use of Methadone, in the case of a recovering heroin addict, considered opiate abuse or long term medication use? Add to that, pt missed her clinic appt and presented to hospital for a dose of Methadone. Do I code v681, Issue of Repeat Prescriptions... (I didn't think so)... how about v638, Specified Reason for Unavailability of Medical Facility? (Clinic was closed over Labor Day weekend) I'm stumped!