Drug Dependence: Coding Flags

Appropriately documented drug dependence codes are associated with increased risk codes and additional capitation payments.

But it’s inappropriate to code them if you’re the one prescribing the medication in question.

So, if you are managing your patient’s chronic pain with opioids, their heroin addiction with Buprenorphine or their adult ADD with amphetamines, then you cannot submit the corresponding dependence codes.

These codes are very commonly submitted, often in error.

The Recovery Audit Contractors know this.

You can be sure these codes will be flagged.  And you will bring increased scrutiny to your other documentation.

Be safe. Don’t submit the drug dependency code, code the underlying condition, the condition for which you’re prescribing those meds instead.

Let someone else code the drug dependence dependence.  For example:  Notify the hospital they should consider adding the code to a recent hospitalization or ER visit.

That way, you’ll still get the extra capitation associated drug dependency, and you’ll be audit-proof too.