The Opioid Treatment Programs Medicare Billing and Payment fact sheet received an update from the Centers for Medicare & Medicaid Services (CMS) back in December of 2020, and it includes new billing and coding policies to use in 2021 when dealing with opioids use disorder (OUD).
Opioids, which are psychoactive drugs, are generally prescribed for pain management. While they’re usually safe when taken as directed, regular use of opioids may result in dependency, and misusing them can be fatal. According to the CDC, nearly 50,000 overdose deaths in 2019 involved opioids, and during the pandemic, the number of opioid overdoses has increased significantly.
Since OUD has been deemed an epidemic back in 2017, prescription opioids have become more regulated. Physicians are on the front lines fighting the crisis, and offering help to those who have opioid use disorder makes a difference. If your office provides these services, here’s a closer look at the latest billing and coding tips to ensure you’re maximizing your reimbursement.
The CMS Roadmap for Fighting the Opioid Crisis
Although prescription opioid overdose deaths have decreased in the last couple of years, there’s still a lot to do to fight the opioid crisis. CMS came up with the CMS Roadmap Strategy to Fight the Opioid Crisis, focusing on prevention, treatment, and continuing to follow the data. Continuing to collect data helps CMS understand opioid misuse and use patterns, monitor trends to see how preventing and treatment efforts are working, and share actionable data to patients, doctors, pharmacies, and more, in an effort to improve the effectiveness of treatment.
Opioid Use Disorder Diagnosis Coding
It’s important to be familiar with opioid use disorder diagnosis coding. Within the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), OUD is defined as a “problematic pattern of opioid use leading to clinically significant impairment or distress.” However, individuals must display a minimum of two of the following behaviors inside a period of 12 months:
- Spending a lot of time using or obtaining an opioid or recovering from the effects of using it
- Taking drugs over a longer period than anticipated or taking larger amounts than intended
- Problems dealing with obligations at home, school, or work
- Constant desire to control or cut down on opioid use
- Increased tolerance of opioids
- Craving opioids
- Going through withdrawal symptoms or taking opioids to prevent withdrawal symptoms
- Continuing to use opioids in spite of recurring interpersonal or social problems
- Continuing to use opioids despite ongoing psychological or physical problems that were likely worsened or caused by opioid use
- Taking opioids in situations that are physically hazardous
- Reducing or completely giving up activities due to opioid use
Coding Tips for Opioid Use Disorder
With the 2020 MPFS final rule, new coding and payment for a monthly bundle of treatment services for OUD were finalized. These services include additional counseling, management of the condition, psychotherapy (group and individual), substance use counseling, and care coordination. Providers may use HCPCS Level II G codes, including G2067 through G2080.
Bundled payment codes G2086 through G2088 now include descriptors that don’t just include the treatment of OUD, but the treatment of any type of substance use disorder. These codes include:
- G2086 – Treatment that’s office-based for substance use disorders. Includes treatment plan development, coordination of care, group and individual therapy, and counseling. For at least 70 minutes within the first calendar month.
- G2087 – Treatment that’s office-based for any substance use disorder. Includes group and individual counseling and therapy, and care coordination. A minimum of 60 minutes in a subsequent calendar month.
- G2088 – Treatment that’s office-based for any type of substance use disorder. Includes group or individual counseling and therapy, coordination of care, and at least 30 minutes beyond the original 120 minutes.
Additionally, there are new add-on codes for Naloxone, which went into effect on January 1, 2021. These codes include:
- G2215 – Nasal naloxone take-home supply; should be listed separately along with the code for the primary procedure.
- G2216 – Injectable naloxone take-home supply; should be listed separately along with the code for the primary procedure.
Opioid addiction continues to be a problem, and anyone can become addicted to pain medications. If you provide services to individuals with OUD, it’s essential to ensure you’re handling your billing and coding correctly. Ensuring claims are thorough and accurate is an important part of the fight against the opioid crisis. M-Scribe Medical Billing can help your practice with OUD billing and coding. Contact M-Scribe today to learn more about how we can reduce denials and help boost your practice’s revenue.