SBIRT - Coding for SBI Reimbursement

Most doctors and nurses don't know this, but reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes.

The Substance Abuse & Mental Health Services Administration or SAMHSA is working with the Centers for Medicare and Medicaid Services (CMS) to educate practitioners about the importance of SBIRT coverage and the Medicare billing rules around these services.

SBIRT services are defined as alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention.

Commercial Insurance billing codes are CPT 99408 and CPT 99409.
Medicare codes are G0396 and G0397
Medicaid codes are H0049 and H0050

You can learn more about SBIRT coverage here and you can also purchase a novel nursing continuing education activity titled the "SBIRT Substance Use NursingMentor" here: cmecorner.com/sbirt

Parents360 Rx Action Toolkit

Every day, more than 2,000 kids use a prescription drug to get high for the first time. Medicine abuse is an epidemic affecting families and teenagers across the country.

The Parents360 Rx Action Toolkit is an easy-to-use tool that you can use to share information with parents and other concerned citizens about the real dangers of medicine abuse and the actions that can be taken to prevent and respond to it. Check it out at pact360.org/programs/parents360rx

ePrescribing final rule, controlled substances update

Register for this complimentary AMA health IT webinar titled, "ePrescribing final rule, controlled substances update."

The Centers for Medicare & Medicaid Services (CMS) final rule on the 2012 Medicare ePrescribing Incentive Program, released Aug. 31, contains various changes of which physicians should be aware.

Register for the Sept. 14 complimentary webinar and learn about:

• exemption categories
• attestation
• incentives
• penalties
• electronically prescribing controlled substances

Date: Wed, Sep 14, 2011
Time: 01:00 PM EDT
Duration: 1 hour
Host(s): American Medical Association

Register here.

Emdeon Supports DEA Option Two for Electronic Prescribing of Controlled Substances

Emdeon Announces Support for Electronic Prescribing of Controlled Substances Using the DEA-Allowed Quicker-to-Market Approach

Emdeon promotes use of a quicker, compliant adoption path for pharmacies and prescribers strapped with competing technology demands

NASHVILLE, Tenn. (August 15, 2011) -- Emdeon Inc. (NYSE: EM), a leading provider of healthcare revenue and payment cycle management and clinical information exchange solutions, today announced its support for the U.S. Drug Enforcement Administration’s (DEA’s) quicker-to-market option for electronic prescribing of controlled substances (EPCS).

On June 1, 2010, prescribers became legally allowed to electronically transmit controlled substance prescriptions to the pharmacy of a patient’s choice, and pharmacies were allowed to electronically receive these prescriptions so long as certain required security measures were in place. Over a year after the DEA Interim Final Rule (IFR) enabling EPCS became effective, the healthcare industry still has not completed implementation of the electronic prescribing software systems necessary to transmit controlled substance prescriptions pursuant to the IFR. Emdeon believes many of the challenges faced by prescribers and pharmacies may be addressed expeditiously through an option that is currently offered within the IFR.

American Board of Addiction Medicine Approves Addiction Medicine Associates’ Training Program for Physicians

Certification in addiction medicine training will help increase number of addiction medicine specialists

Brookline, MA, June 30, 2011 --(PR.com)-- Addiction Medicine Associates today announced that the American Board of Addiction Medicine (ABAM) has approved the organization to offer a one-year training program in addiction medicine for physicians. The first physician has been accepted into the program and will be starting in the summer of 2011. Once training is successfully completed, the physician will be able to take the board examination in December 2012. According to Dr Wendel Price, the physician selected for the program, “The training of Primary Care physicians does not get into addiction treatment to any real degree and a comprehensive training program would be invaluable”

The impact of medical marijuana on youth living in Denver

Yesterday, I had a very fascinating discussion with a physician about medical marijuana use in the state of Colorado. Medical marijuana is becoming a booming business for doctors. I learned quite a bit about dispensaries and all the different forms of medical marijuana that are being sold to people who carry a medical marijuana card.

Then, I stumbled on this post on the government blog OfSubstance, titled, "Marijuana and Youth – Experiences From a Practicing Physician." In that blog post, Christian Thurstone, M.D., writes how half the patients who are in the substance abuse treatment program are getting marijuana from people who carry a medical marijuana license. Some young adult patients in treatment for marijuana addiction have marijuana licenses.

Interim Final Rule: e-Prescribing for controlled Substances

Today, the Drug Enforcement Agency (DEA) published an Interim Final Rule regarding electronic prescriptions for controlled substances on the Federal Register. This is now open for comment, and then we can anticipate that it will get finalized.

Several websites seem to have the wrong link to the PDF, so here's the correct link that will open up the Interim Final Rule:  http://edocket.access.gpo.gov/2010/pdf/2010-6687.pdf

It's an 85-page PDF and I can guarantee it will put you to sleep tonight. 

Federal Register Vol 75, No. 61 Wednesday, March 31, 2010

Patient accused of shooting and killing Kentucky doctor

This a very sad story. According to several news sources, a patient allegedly shot and killed a physician in Kentucky. Kentucky state police said John C. Combs, 46, was arrested for allegedly shooting Dr. Dennis Sandlin, 57, Tuesday morning at the Leatherwood-Blackey Clinic.

The short version is that the patient supposedly asked for some narcotic pain medications and was refused. He made some treats to the doctor, and then returned and shot the doctor.

A Perry County sheriff's deputy said Combs had asked for narcotics but was required to give a urine sample, which he refused to do. "From that point, he got real angry, he just went crazy, and he made a threat he was going to come back and blow up the building," said Sam Mullins, who responded when the clinic called about the threat.

Wow, this is quite a shocking story. In the past, there were times when I refused to give narcotics to patients who demanded them. Some are drug seeking. Some are addicted. Some sell the drugs on the street. Some abuse it for pleasure.

Dr. Sandlin graduated from the University of Louisville medical school and had been a doctor in Kentucky since 1978. His practice focused on older patients with chronic illnesses and he was active in Hospice.

My heart goes out to Dr. Sandlin's family and friends.

Nurse sentenced for tampering with and diverting Demerol

Drea Lynne Gibson, 43, of Fall City, Washington, was sentenced in U.S. District Court in Seattle to a year and a day in prison and three years of supervised release for tampering with and diverting Demerol (meperidine), a narcotic pain medication. Gibson was a nurse at the Bellevue Surgery Clinic and she was diverting Demerol and even replacing the ampules with saline. To read the full story, click here.

This really is a sad story and goes to show that even health care professionals are susceptible to drug abuse, misuse, addictions and other serious problems. I hope that she gets the help she needs so that she can recover from her drug addiction and find her place back in society. She will probably need some serious rehab and counseling. I know many health care professionals who have fallen to alcohol and drug misuse. There's hope for everyone because drug addictions can be treated and managed effectively.

National Institute on Drug Abuse provides new resource

The National Institute on Drug Abuse (NIDA), a part of the National Institutes of Health (NIH), revealed a series of new educational resources through its Centers of Excellence for Physician Information Program (NIDA CoEs).

Why this new resource? There's a tremendous need for medical education on this topic.

Drug abuse and addiction are often insufficiently covered in medical school curricula, despite the fact that drug use affects a wide range of health conditions and drug abuse and addiction are themselves major public health issues.

It's great to see the government investing some much needed resources in this area. Here's a brief summary of what you can expect:

The new NIDA CoE curriculum resources provide scientifically accurate information on substance abuse, addiction and its consequences to help meet the educational needs of medical students, residents and medical school faculty. The first seven curriculum resources include lectures, problem-based case studies, a faculty workshop, and a web module, any of which can be incorporated into existing medical curricula.

To learn more, visit: http://www.nida.nih.gov

A non-controlled substance drug for ADHD: Intuniv (guanfacine) ER

Shire has announced that the FDA has approved Once-Daily INTUNIV (guanfacine) Extended Release Tablets for the Treatment of ADHD in Children and Adolescents Aged 6 to 17.

INTUNIV, the first nonscheduled alpha-2A receptor agonist indicated for Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrated improvement in a range of ADHD symptoms that can be disruptive, such as inattention, arguing with adults, hyperactivity, impulsivity, and losing one's temper.

What's interesting is that INTUNIV is not a controlled substance by the DEA and has no known potential for abuse or dependence. Don't get this drug confused with guaifenesin (which is found in many common cold medicines). Look at how similar they are:

• guanfacine
• guaifenesin

OK, maybe they're not that similar, but if you have any problems with attention, then you may miss the obvious. Just call it Intuniv and I think you'll be safe from accidentally getting any of these guaifenesin products:

Anti-Tuss, Bidex, Breonesin, Duratuss G, Fenesin, Ganidin NR, GG 200 NR, Guaifenesin LA, Guaifenex G, Guaifenex LA, Humibid L.A., Humibid Pediatric, Liquibid, Muco-Fen 1200, Muco-Fen 800, Muco-Fen LA, Naldecon-EX Senior, Organidin NR, Pneumomist, Q-Bid LA, Robitussin, Scot-Tussin, Touro EX

Prescription drug abuse - who's fault is it?

CNN has a story about prescription drug abuse because a recent celebrity (I think we all know who) may have had some problems related to pain pills and sedatives. The story starts with this line:

People who abuse prescription drugs often do so believing the pills are safe because they are prescribed by doctors and approved by the Food and Drug Administration, addiction experts tell CNN.

When we look at the recent statistics, we realize that this is a huge problem:

In 2005, non-medical use of painkillers contributed to more than 8,500 deaths. Overdose deaths involving prescription pain relievers increased 114 percent from 2001 to 2005.

Perhaps the media is to blame? Do you feel that celebrity death stories (related to drug abuse) have been glamorized in any way? We all know that many celebrities have problems with substance abuse. How does that get portrayed to young people living in America?

By 2008, according to the Drug Enforcement Administration's Web site, 38 states had passed legislation to create a database for physicians and pharmacists to prevent abusers from obtaining multiple prescriptions.

Many drug addicts are very sophisticated and they have developed clever schemes to beat the system. Some have multiple identities. Others cross state lines and they eventually learn where they can go for their drugs.

So who's to blame for this drug abuse problem? The doctor? The patient? The drug company? The FDA? Or "all of the above"? What can be done to alleviate this common problem? Certain patients refuse to take controlled substances because they fear addiction. Some physicians
To read the story, click here.

CNN's Sanjay Gupta: Xanax is highly addictive

Xanax (alprazolam) is a DEA controlled substance because it's highly addictive.

The Addictive Potential of ADHD Stimultants According to JAMA

Provigil® (Modafinil) is a stimultant drug that is used to treat attention-deficit/hyperactivity disorder (ADHD). It is also a drug that is often misused by students to help them increase their study performance, and there have been many ethical debates on this issue. At what point does "off-label" cross ethical boundaries?

Recently on JAMA, an article came out titled, "Effects of Modafinil on Dopamine and Dopamine Transporters in the Male Human Brain: Clinical Implications." Can you guess what it was about? Students who are really driven are often looking for ways to increase their grades (unless they easily get straight A's and they're already at the top of their class). The misuse of stimulants has been such a hot topic recently. The authors of this JAMA article concluse that, "Because drugs that increase dopamine in the nucleus accumbens have the potential for abuse, and considering the increasing use of modafinil, these results highlight the need for heightened awareness for potential abuse of and dependence on modafinil in vulnerable populations."

What exactly does this mean? Provigil is a Class IV controlled substance and is in that class with benzos and anabolic steroids.