ED Coding and Reimbursement Alert

If your opioid prescription count is higher than average, don't panic, reps say.

Many ED providers see patients presenting with pain every day – in fact, the American College of Emergency Physicians reports on its website that 42 percent of ED visits "are related to painful conditions." This often means that patients request - or require - pain medication prescriptions, but because of an increasing number of accidental overdoses of these drugs, physicians must use extreme caution when prescribing them.

A new Comparative Billing Report (CBR) from Part B MAC Palmetto GBA outlines some of the national statistics on opioid prescribing to help you figure out how your ED compares to other opioid prescribers.

Background: In its CBR released March 7, Part B MAC Palmetto GBA focused on claims issues, trends, and benchmarks that the payer has seen for Medicare providers who prescribe opioids. Palmetto initiated the analysis due to "concerns raised about extreme opioid use, and to share the latest thinking from the medical community on appropriate prescribing of opioids."

Remember: The feds use CBRs as a tool to offer insight into billing and coding trends across different specialties and healthcare settings. CMS partners with its contractor eGlobalTech to produce the reports, which you can find at www.cbrinfo.net. You can use this timely data from Palmetto GBA's CBRs to see where you stand when it comes to the frequency of billing certain services, codes, or modifiers - and more importantly, utilize these peer measurements to eradicate your practice coding problems.

"In the US every day, more than 1,000 people are treated in emergency departments for not using prescription opioids as directed," said Jan  Losby,  PhD,  MSW,  from the Centers for Disease Control, during a webinar describing the audit findings. To try and get that number down, the CDC, along with other stakeholders, presented some statistics that might help your ED figure out where it stands in the prescribing arena.

EDs Rank High in One Category

To create the data used in the CBR, CMS reviewed information from about 25,000 providers who prescribed opioids between July 1, 2016 and June 30, 2017, but excludedpatients with cancer diagnoses or who were in hospice, said Cheryl Bolchoz,  lead data analyst with Palmetto GBA. She offered nationwide benchmarks for opioid prescriptions, which we've listed below, along with emergency physicians' statistics. As you can see, ED physicians only had a higher than average outcome in one category.

As the chart above notes, emergency physicians have a higher than average rate of prescribing opioids to patients who are getting prescriptions from four or more prescribers.

EDs should take a look at their own statistics in each category and compare them to the emergency physician stats in the third column above. Keep in mind that if you are above the average in any of the benchmarks above, there's no need to panic. "Some practitioners have subspecialties or distinctive focuses that are not apparent in prescribing data," said Palmetto GBA's Tamara Canipe, RN, during the webinar.

For example, she said, the physician may be practicing in an underserved area or in a region with a higher proportion of sicker Medicare beneficiaries. If, however, your statistics indicate you report opioids more than the average "and you are not confident of the reason why you are different, then you may want to perform a self-audit using guidance from today's presentation," Canipe said.

Could Gabapentinoid Reviews Be Next?

The Food and Drug Administration has four priority areas regarding opioids, said the FDA's Scott K. Winiecki, MD, during the webinar. They are:

• Decreasing exposure and preventing new addictions
• Supporting treatment of those with opioid use disorders
• Fostering the development of novel pain treatment therapies
• Improving enforcement and assessing the benefit-risk

CMS is also reviewing prescription patterns of gabapentinoids, said CMS' William Fleischman, MD, during the webinar. "Gabapentin is usually prescribed to treat nerve pain such as fibromyalgia, restless leg syndrome, and peripheral neuropathy, post-herpetic neuralgia and seizures; but now it is being utilized as an alternative to opioids for chronic pain," he said. CMS is "likely" to focus on gabapentin use in future monitoring, analyses, and CBRs, Fleischman said.

Resource: To read the complete CBR, visit https://cbrinfo.net/node/350.