# When to code drug dependence?!



## LindaKrarup (Jun 4, 2009)

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!


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## 1073358 (Jun 5, 2009)

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


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## LindaKrarup (Jun 5, 2009)

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.


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## 1073358 (Jun 5, 2009)

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.


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## kevbshields (Jun 8, 2009)

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.


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## mitchellde (Jun 8, 2009)

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


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## katrinabgood (Sep 17, 2009)

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!


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