Screening and Brief Intervention Billing Codes for Physicians

Screening for a drug or alcohol problem in the doctor’s office seems like a logical and appropriate thing to do. However, only 8.7% of problem drinkers report receiving such screening or advice from their doctors. Physicians now have an incentive to do Screening and Brief Intervention (SBI) because this service is now billable:

• American Medical Association created codes 99408 (15-30 minutes) and 99409 (over 30 minutes interaction) for alcohol and/or substance use structured screening and brief intervention services

• Center for Medicare & Medicaid Services created codes H0049 and H0050 for alcohol/and other drug screening and brief intervention.

• Centers for Medicare & Medicaid Services created codes G0396 and G0397 for reporting comparable services for Medicare fee-for-service schedule (FFS) patients.

So what is a brief intervention? For alcohol, one example would be to use the National Institute on Alcohol Abuse and Alcoholism (NIAAA) one question:

How many times in the past year have you had 5 or more drinks in a day (men); 4 or more drinks in a day (women)?

To determine if there needs to be some sort of intervention, the following must be kept in mind:

• One standard drink = 12 ounces beer, 5 ounces of wine or 1.5 ounces of 80-proof spirits
• Drinking limits for healthy women to age 65 = no more than 3 drinks in a day AND no more than 7 drinks in a week
• Drinking limits for healthy men to age 65 = no more than 4 drinks in a day AND no more than 14 drinks in a week

The 2006 National Survey on Drug Use and Health (NSDUH) found that 21.1 million people needed, but did not receive, treatment for illicit drug or alcohol use. 95.5% felt they did not need treatment. A brief talk with their doctor may be enough to change their mind (and their lives).

Source: TIPS & TOPICS from David Mee-Lee, M.D., Volume 6, No.1, April 2008

More info on screening:
Screening for alcohol use and alcohol related problems (NIAAA)
Many Health Plans Will Now Pay for Substance Use Screening and Brief Intervention
Simple steps can help curb opiate misuse in doctor’s offices, study shows
Advice from Addicted Women to Nurses, Doctors, Medical Staff
Screening for Problem Drinking at the Doctor’s Office Saves Money
Online Alcohol Screening Tools Help Employers Save Money

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Simple steps can help curb opiate misuse in doctor’s offices, study shows

Researchers from the University of Michigan and Ohio State University have come up with some simple steps to help doctor’s offices reduce the abuse of Oxycontin and other painkillers and help those that that may need substance abuse treatment. The study was conducted in a busy multi-physician clinic at Ohio State University that was resident-staffed and faculty-supervised.

Because it is difficult to predict who will abuse or misuse opioids, the policy the researchers came up with was applied to all patients receiving opioid prescriptions at the clinic. Four steps were taken:

1. Create a registry of all patients receiving opioid prescriptions, along with their prescribing clinic physicians.
2. Using Ohio’s online prescription database, monitor whether or not patients were “doctor shopping” in an attempt to get the same drug from many providers.
3. Require patients and doctors to sign a mandatory agreement that listed the monitoring steps to be taken for clinic patients requesting opioids and the consequences if certain conditions or behaviors came about.
4. Conduct annual and random urine screening for all patients requiring opioids for non-cancer pain to check for illicit drugs or other prescriptions that could interact dangerously with the prescribed opioid.

In all, the study revealed that 35% of the 167 patients in the clinic’s opioid registry violated the new policy in some way. Patients who were receiving Oxycontin or another medicine that contained its active ingredient, oxycodone, were twice as likely as other opioid registry patients to violate the clinic policy. Most violations were due to failed drug tests that showed illegal drug use or getting prescriptions from multiple physicians. Those that showed dependence or abuse were referred for treatment.

Read More
Study shows doctor’s offices can help stem abuse of narcotic painkillers

Advice from Addicted Women to Nurses, Doctors, Medical Staff

Screening for Problem Drinking at the Doctor’s Office Saves Mone

Technorati Tags: oxycontin, opiates, abuse, doctors, study