Opioid Use Disorder is defined by the DSM-5 as a “problematic pattern of opioid use…”

A code of F11.20, opioid dependence, should not be assigned for patients taking pain medication as prescribed.Instead a code of Z79.891, long term use of opiates, should be assigned.

Coders should always be mindful of ICD-10 Guidelines and Coding Clinic Guidance when assigning codes for substance use disorder.

2021 ICD-10 Guidelines (pages 43-44)

Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)

b. Mental and behavioral disorders due to psychoactive substance use

3. Psychoactive Substance Use, UnspecifiedAs with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a physical disorder included in chapter 5 (such as sexual dysfunction and sleep disorder), or a mental or behavioral disorder, and such a relationship is documented by the provider.

AHA Coding Clinic Guidance

Question:Medical record documentation indicates the patient is taking opioids prescribed by their physician for treatment of chronic pain. Does Guideline I.C.5.b.3. mean that codes cannot be assigned for the opioid use unless there is documentation of an associated physical, mental or behavioral disorder?

Answer:A code for the use of prescription opiates would not be reported because there is no associated physical, mental or behavioral disorder.

Reference: AHA Coding Clinic 2018 2nd Quarter, pages 11 and 12

Learn more or download a copy of DSM-5 Criteria here https://erm365.org/opioid-use-disorder/

2021 CMS-HCC Coding Tool ExampleWe have received several requests from physicians, coders and administrators for an “MRA Cheat Sheet”.Many have asked for something that is a single page or similar in format to a “charge slip”. So, I wanted to share a simple example of one that could be used for primary care providers. View or download below. Visit www.ERM365.org for more risk adjustment tools and information!

Due to extremely high demand, new dates have been added for the 2021 workshops!

KEY TOPICS INCLUDE:

Vast changes are coming to Medicare risk adjustment in 2022 and beyond. Is your team ready?

What are the potential impacts to your revenue without RAPS?

Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?

What are the components of a risk score and how is it calculated? What is the impact of the payment count?

Review NEW HCCs and see what documentation is needed to validate payment.

Simple steps for optimizing risk adjustment operations and associated revenue.

Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding.

WHO SHOULD ATTEND?

Physicians and Other ProvidersCoders, CDI Specialists and AuditorsNurses, Medical Assistants and ScribesMedical Directors and CIOsMA, Medicaid and Commercial PlansACO, MSO and IPA TeamsHospitals and Academic CentersCommunity Health, RHCs and FQHCsHealth Alliance Members

EACH ATTENDEE WILL RECEIVE:

Color PresentationCME / CEU / CE Certificate (Approved by the AAPC, AMA, AAFP and CCMC)HCC Coding Tools Download25% off any HCC Tools ordered within 14 days of the event.

HOW DO I REGISTER?

Register here for Friday, February 19, 2021

Register here for Friday, March 26, 2021

Register here for Friday, April 23, 2021

Register here for Friday, May 28, 2021

WHAT IS THE COST?

Tickets - $49  

Bring the Whole Team and SAVE 10% on 3 or more tickets!!

WHERE CAN I LEARN MORE?

Visit ERM365 (www.erm365.org/events) to learn more.

Download the agenda / flyer