Opioid Use Disorder

Based on the 2017 National Survey on Drug Use and Health, Mortality in the US 2016, an estimated 11.4 million people misused prescription opioids, 2.1 million developed opioid use disorders with 47,600 resulting in death from opioid overdose. This is over 30,000 more opioid overdoses than the 15,482 deaths related to heroin overdose. As such, Health and Human Services recognized the opioid crisis as a public health emergency.

How did this happen? Opioids were not revealed to be addictive. Due to their effectiveness, they became a popular prescription for pain relief. As addiction developed, abuse and misuse followed.

What is Opioid Use Disorder? OUD is a “problematic pattern of opioid use leading to clinically significant impairment or distress.” A diagnosis of OUD can be confirmed by observing only 2 of 11 criteria within a 12-month period. For example, opioids are taken for a longer period of time than intended and discontinuing activities due to opioid use combined could be used to confirm OUD. For a complete list of criteria, visit cdc.gov.

Because of the growing concern around the opioid crisis, CMS requires Review of Opioid Use in its Initial Preventive Physical Exams (IPPE) and Annual Wellness Visit (AWV). It is a routine element of a patient’s medical and social history which requires physicians to review opioid use, assess risk for misuse, and review alternative pain therapies. Since AWVs occur yearly, this review could diagnosis and treat OUDs in the earliest stages.

Be sure your providers are documenting Review of Opioid Use along with the other required elements to accurately bill IPPEs and AWVs. Check with other payers for their guidelines around this initiative to reduce opioid misuse. Need help with reviews and/or documentation improvement? Check out Lighthouse Healthcare Advisors Coding & Compliance Services.





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