Wiki HELP PLEASE - Has anyone billed for Medical Marijuana? Need direction on codes

[gr8gal61]

I am attempting to assist an M.D. that has an established "innovative medical care" practice that is going to incorporate seeing patients for their medical marijuana card. This is considered legal in the state of Illinois. They currently do cash pay patients only at a flat rate. He has been informed that filing claims through the patients' insurance company will maximize his revenue. I agree HOWEVER after much investigation, it appears that no insurance companies are paying for this service, even though it is legal in the state.

My questions are: if they have previously seen the patient, regardless if the patient paid cash or not and they come in for a follow up, the patient is still considered an "established" patient, correct?

Would it be possible to charge a preventative visit 99381-99397 along with an E&M IF an abnormality is encountered and addressed during this preventative visit? I say yes but wanted someone to confirm or deny.

I am concerned because insurance is not currently covering this service yet he has been told by another physician to simply NOT include the drug dependence & or long term use. Based on what I know, this is withheld information and the insurance company could easily come back and recoup their money not to mention what all else.

I have read that some employees have been fired because of the so called new legal program. It is coinciding with their company policies of random drug testing and have been found to have marijuana in their systems!

I want to have full knowledge of this before I move forward as I have worked too hard to obtain and keep my certification in good standing.

Any help would be greatly appreciated.

Thank you

 

[Lajolla21]

Hope this helps

Hello,

The Dept of Pub Health in IL may pay for it via pilot program/the patient has a qualified illness-- http://dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis

E/M--An established patient is one that's been seen w/in the last 3 years at that group by their doctor or another member of the group of that same specialty (check your CPT-E/M section). It has nothing to do w/ how the patient paid their bill (paying w/ cash vs insurance is harder to track).

Preventive--generally yes (see the E/M of the CPT)-- The Dr. should be doing the preventive, find something 'abnormal/preexisting' during the preventive exam that's significant enough to fit all the requirments in an E/M code. Then you bill the E/M w/ mod-25 since the E/M is done on the SAME DAY as the Preventive. 25 is your "i'm here for a ck up but oh by the way, I have an unrelated spider bite on my foot"

In lieu of the preventive, is he trying to get the E/M covered and that's why he wants to bill insurance? You cannot alter medical records. If that's why he entered, that's what you bill. if he does not want the drug dependence or long term use billed, he needs to remove it/note the error in the record. Also remember, this may not be the patient's only provider. if you did omit that from your billing, if other providers did not omit it/do bill it, when the insurance sees both claims, it can raise eyebrows. It reminds me of the False Claims Act w/ the OIG http://oig.hhs.gov/compliance/physician-education/01laws.asp

 

[mitchellde]

Just to clarify a person prescribed medical canabis is not to be coded a a drug dependent, no more than a person that is prescribed oxy a drug dependent, no more than a person prescribed medical cocaine or heroin is a drug dependent. Please do not use the F codes for drug use or drug dependent so for these patients. They live where this is a legally obtained and prescribed therapeutic treatment for their condition. You can agree with the law or disagree but it does not make them a drug user, abuser, or dependent.
So you code them the same as you would any other patient that is being treated with legal prescriptions from your provider. The canabis product however s not going to be covered by the patient's prescription plan ,more than likely. You cannot help them with that.

 

[CodingKing]

Be careful with the "Bona-fide physician-patient relationship" requirement. He cant just see patients for the purpose of giving a medical marijuana cards. It sounds as if he needs to either be the patients primary care physician or the physician treating the patient for their condition on the approved list by the state of IL. Just like a physician wouldn't prescribe Oxycontin and send the patient off without an expectation that their treatment will be monitored. Also if they are coming in to get their certification, i would not be billing a preventive visit. If they are coming in related to their existing medical condition its not a preventive exam. I'd suggest having the patient come in a different day for the certification than the routine physical.

From the physician certification form:

http://dph.illinois.gov/sites/defau...annabis-physician-written-certification_1.pdf

Have established a bona-fide physician-patient relationship with the qualifying patient applicant. The
qualifying patient is under my care, either for his/her primary care or for his/her debilitating medical
condition, as specified on this form. This bona fide physician-patient relationship is not limited to a
recommendation for the patient to use medical cannabis or a consultation simply for that purpose.

Definition of Bona fide physician-patient relationship from the pilot program FAQ

http://www.illinois.gov/gov/mcpp/Documents/DPH FAQ 080814.pdf

“Bona fide physician-patient relationship” means a relationship in which the physician has ongoing
responsibility for the assessment, care and treatment of a patient’s debilitating medical condition, or a symptom
of the patient’s debilitating medical condition, for which the physician has certified to the Illinois Department of
Public Health that the qualifying patient would receive therapeutic or palliative benefit from the medical
cannabis.

I'm glad to see that they are treating it just like another treatment modality vs a way for recreational users to get around the law. Its one of the things I find to be a joke about the program in CA where you have a person standing outside the office trying to get random people on the streets to come in. They see the doc one time for the sole purpose of getting the card with no expectation of establishing as a patient of the physician.

Now as to the part about getting fired, having the medical marijuana certificate protects you from criminal prosecution at the state level, It does not protect you from employer drug screen polices. Also remember marijuana is still illegal at the federal level so its possible even the ADA may not protect you.

http://www.nolo.com/legal-encyclopedia/can-i-fired-because-i-medical-marijuana-disability.html

If you have any legal questions you may want to refer you physician to check with their legal council as that's outside the scope of a medical coder, biller or practice manager function

 

[mitchellde]

In no way was I meaning to address a situation of enticing persons to obtain a medical card for the purpose of recreational use. I guess I am just one that believes if you are a certified coder and asking a question in this forum, then it is for legitimate medical patients. I cannot even try to see how you would code an encounter for a visit where the patient has no legitimate complaint to obtain a prescription. I guess they are out there and they give scripts for more than canabis. But I am not thinking they are concerned with submitting claims to insurance. I was addressing legitimate patients with legitimate complaints where treatment with canabis has been proven effective. The physician should have no problem billing these encounters. Since you will be using the code for the chronic problem such as pain or neoplasm and the code for long term drug use. You are not covering anything up and you are coding exactly what is documented.
The problem I have discovered is that some coders are using the F codes for drug dependence when a prescription drug is used. This is incorrect and it does not matter if the drug is Coumadin or canabis. These are not drug dependents, they are patients receiving prescribed medical treatment.