Wiki HELP PLEASE - Has anyone billed for Medical Marijuana?

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gr8gal61

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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
 
In a state that has legal medical cannabis, you treat those patients no different than patients on any other prescribed medication. In other words a patient who is prescribed oxy for pain relief is not coded as a drug dependent so neither is the medical canabis user. These are are not drug users! They are simply following a prescription regime per doctor orders. They are not buying this from the corner drug dealer, they are going thru state sanction supply vendors. So you code them as you would any other patient. An annual is an annual using the Z00.- diagnosis. You should never use an F code for drug dependence or drug user or drug abuser as long as the provider documentation supports the patient is following the instructions. So yes they are covered by insurance for everything except the supply of the canabis. Also their follow up encounters will be coded with the chronic diagnosis such as the G89.- codes for chronic pain, along with the Z79.- code for long term use of drug. The visit to test for drug use will be coded with the Z51.81 plus the Z79.- for drug monitoring. The payer will cover what the patient has signed up for, they should not be expected to pay for provider visits out of pocket just because the prescription says canabis and not oxy.
 
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