# UA Billing (pain management)



## JBS  (May 17, 2016)

I have a question regarding billing for a UA (attached to a office visit). I have two codes F12.20 (cannabis dependence, uncomplicated) and Z79.891 (long term current opioid use). I believe the general rule is if there is a dependence code and a use code to throw out the use code and just bill using dependence (ex: f11.20(opioid dependence, uncomplicated and z79.891(long term current opioid use) we just use f11.20), but since these are two different drugs can we bill using both, or should the use still be thrown out? Thank you! Jenn


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## CodingKing (May 17, 2016)

Someone already responded to your other post of the same thing - https://www.aapc.com/memberarea/forums/137254-billing-ua.html

This is therapeutic drug monitoring for a prescribed substance. That is not the same as drug dependence which means the patient is abusing drugs.


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## JBS  (May 17, 2016)

I apologize, I was not clear on the previous answer, which is why I re-posted it under pain management.

The Dr. has already documented and diagnosed the patient, so we are not looking for a diagnosis, simply should one of the codes be thrown out or should they both be used when we will bill out the UA. I appreciate any help on this.  Thank you!


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## CodingKing (May 17, 2016)

All you need to do is ask for clarification in the original post. mitchellde knows a lot


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## mitchellde (May 17, 2016)

Thank you coding King!  However the diagnosis is the issue.  If the provider attached the codes then it needs to be shared with the provider that the F codes for drug use and a dependence indicate a mental and behavioral issue of drug addiction.  These are not codes that indicate pain relief using drugs.  By indicating cannabis dependence and or opiod dependence or use and then dispensing these drugs, well it looks as though you are a drug dealer and not a therapeutic healer.  If the patient is not a drug addict dependent on illicit use of drugs to make it through the day then you should not be using the F codes at all.  The correct way to code for a UA check is the therapeutic drug monitoring code, Z51.81 with long term or current use Z79 code, you can use the G89 code for the acute or chronic pain last.


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## JBS  (May 17, 2016)

We are not here to debate ethics. We are not asking to have the patient diagnosed. It is a NEW patient who reported cannabis dependence and opiate use. The physicians diagnosis is not up for debate. It was simply a question of which code to use or use both of them as they are separate reported diagnosis. A UA was obtained to confirm the oral history given to the physician. Where did we report that the physician dispensed narcotics to this patient?  We asked a legitimate question regarding coding and the thread jumped to conclusions and handed out diagnoses. I appreciate your expertise and opinions, I don't think the answer I was needing was actually coming across in my original thread! Thank you!


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## CodingKing (May 17, 2016)

If you attach an F code to this patient for prescribed opiate treatment you are diagnosing the patient. By misreporting the DX you are messing with the patients livelihood and opening yourself up your practice to legal issues. You should always question the physician when thing don't add up and in this case they don't.

Z79.891 & F12.20 are the appropriate codes to use for self reported cannabis use and prescribed opiate use.


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## mitchellde (May 17, 2016)

You indicated pain managementand then cannabis and opiod dependence. With no further information this can be seen as pain management with legal cannabis or opiod drugs or both.  In pain management it is a standard that regular drug testing occurs to be certain that the patient stays wishing prescribed therapeutic measures.  I have performed many audits and many coders are using the F codes to indicate that the patient is on these drugs which is incorrect. From the information you provided it appeared to be the same scenario.  I am unsure now what you are asking, I will need the encounter note to be of further assistance.


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## JBS  (May 17, 2016)

CodingKing said:


> If you attach an F code to this patient for prescribed opiate treatment you are diagnosing the patient. By misreporting the DX you are messing with the patients livelihood and opening yourself up your practice to legal issues. You should always question the physician when thing don't add up and in this case they don't.
> 
> Z79.891 & F12.20 are the appropriate codes to use for self reported cannabis use and prescribed opiate use.






I am not diagnosing anything, our physician has made the diagnosis. He came to this decision based on the information directly from the patient, the OBN (narcotics prescribed by other physicians) and the results of a positive UA for both opiates and THC.  Legally the Dr. is documenting what was reported to him and confirmed. As far as the patient's "livelihood" the patient admitted himself to doing illegal drugs.


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## JBS  (May 17, 2016)

mitchellde said:


> You indicated pain managementand then cannabis and opiod dependence. With no further information this can be seen as pain management with legal cannabis or opiod drugs or both.  In pain management it is a standard that regular drug testing occurs to be certain that the patient stays wishing prescribed therapeutic measures.  I have performed many audits and many coders are using the F codes to indicate that the patient is on these drugs which is incorrect. From the information you provided it appeared to be the same scenario.  I am unsure now what you are asking, I will need the encounter note to be of further assistance.




Debra,

Are you saying if a patient is using cannabis (or any illegal drug) we are not suppose to use a F code at all, when billing for a UA? I'm a little confused.


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## CodingKing (May 17, 2016)

ICD-10-CM guidelines is the best place to get this information

I.5.b.2



> *Psychoactive Substance Use, Abuse And Dependence*
> 
> When the provider documentation refers to use, abuse and dependence of the same substance (e.g. alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy:
> 
> ...


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## JBS  (May 17, 2016)

Thank you!


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## mitchellde (May 17, 2016)

If the physician is prescribing the drug then that is correct you do not use the F codes to indicate drug dependence or drugs use.  If the provider documents (not patient history related) that patient is drug addicted then yes you will.  However having worked in pain management it is unlikely that a physician will prescribe pain narcotics to a patient with a drug addiction. If the patient indicates they have abused drugs in the past and the provider wants to see if the patient has evidence of opiod or THC in their system then you would use a Z code for screening.


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## JBS  (May 17, 2016)

Is this information explained anywhere?  We have looked  and haven't found any information explaining the use of F codes this way.  I would like to read up on this and make sure we are billing this correctly. If you do know of anything can you please direct me there! Thank you for your help!


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## mitchellde (May 17, 2016)

The chapter explains the codes.  The F codes are mental and behavioral codes.  And the F codes for drug use and dependence and abuse specify due to misuse of the substance.  This should all be in your code book.


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