CII script change

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pharmacisttotherescue

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Hey everybody,

Im pretty new to this and am a recent pharmacy grad. I currently am a floater for a chain and I had a question for a CII I filled my first week of practicing that I still debate was the right move or not. So I got a script for norco from a usual patient of the pharmacy it was for norco 10/325, 1 po q 8 hrs prn pain #270 90 day supply, and the patient said she its suppose to be 1 po q6 #360 as what she normally was getting, which was accurate upon checking her profile. So I called the MD office to see if I could make the change(im in CA and I know the law is CII must have MD signature and date in there writing, everything else can be changed with a verbal), upon speaking with the MD office, it was approved for the same sig 1 po q6 #360, 90 days, I however didnt ask for DX code, because she was a regular, but I still should of (regret it), how do you guys think I handled the situation? should I have said I need a knew script from MD or was the verbal okay?any suggestion/feedback helps. thank you.
 
pharmacisttotherescue said:
Hey everybody,

Im pretty new to this and am a recent pharmacy grad. I currently am a floater for a chain and I had a question for a CII I filled my first week of practicing that I still debate was the right move or not. So I got a script for norco from a usual patient of the pharmacy it was for norco 10/325, 1 po q 8 hrs prn pain #270 90 day supply, and the patient said she its suppose to be 1 po q6 #360 as what she normally was getting, which was accurate upon checking her profile. So I called the MD office to see if I could make the change(im in CA and I know the law is CII must have MD signature and date in there writing, everything else can be changed with a verbal), upon speaking with the MD office, it was approved for the same sig 1 po q6 #360, 90 days, I however didnt ask for DX code, because she was a regular, but I still should of (regret it), how do you guys think I handled the situation? should I have said I need a knew script from MD or was the verbal okay?any suggestion/feedback helps. thank you.
Click to expand...

You can change the name of the drug?

I don't see the issue personally. You only changed the sig and the quantity, correct? Seems fine to me.
 
I respectfully submit that as a new grad you are suffering from "overthinking it". Why would you ask for a diagnosis code anyway? Is that a company policy or state law or something? I wouldn't have asked for it either in that situation.
 
I mean the dx code would of made me feel a little more at ease because its not everyday I dispense #360 norcos, its not company policy but in general I like to get a dx code for controls especially C2's.
 
Which diagnosis code, specifically, would have made you feel better about filling #360 Norcos? Not to be a dick but I have never understood what having a diagnosis code would do for someone. I guess you can check to make sure the code is something pain related, but it is bound to be, right? I never understood the fascination with diagnosis codes.

No one can tell you if you made the right call to dispense that many. I will say I have many times, but that I am also glad to be out of retail and having to make those kinds of judgement calls.
 
yes, basically to reassure that it was written for a legitimate purpose, and not for some addict, which would also help sleep better at night
 
pharmacisttotherescue said:
yes, basically to reassure that it was written for a legitimate purpose, and not for some addict, which would also help sleep better at night
Click to expand...

Well if you ask for a diagnoses code and the physician or their agent gives you a diagnoses code for addiction at least you can feel good about denying it and reporting that physician to the BOM. I do not think that has ever happened though. 🙂

Someone remind me, it is illegal to prescribe opioids to maintain an addiction, right? I hope I am not making that up in my head, lol

My point is you will always get a diagnosis code related to pain. It’s just a matter of which BS diagnosis code you will get (IMO).
 
I would be suspicious, only allow the md themself to clarify definitely not an agent of the md since they might have been wanting the pt to start tapering off. I wouldn't trust a random md office worker to understand a pts medical treatment plan.
 
OP, I know as a new grad, quatities like that may make you be extra cautious, but that's a 90 day supply, so 120 per month, which isn't out of the norm.

I think with controls in general, you just have to treat the patient, and not hte script. Check their entire profile, use your state PDMP, check their filling history if there were cases of early fills...
 
you did fine

if you think that's a lot of Norco just wait till you get a script 1-2 tabs q4-6h #30 days supply lol
 
It is unlawful to prescribe opioids for maintenance except buprenorphine presentations under a DATA waiver.

PART 1306 - Section 1306.04 Purpose of issue of prescription

The point of asking for DX codes, recent charts etc. is to cover your ass (show you practiced corresponding responsibility) when the BOP shows up, like how to explain why you filled this large quantity Rx non-stop without question for the last 3+ years.

Yes FWIW I think it is mostly B.S. especially for primary care prescribers, who don't care about treatment plan or goals and just don't want to piss off their customers.
 
Charcoales said:
I would be suspicious, only allow the md themself to clarify definitely not an agent of the md since they might have been wanting the pt to start tapering off. I wouldn't trust a random md office worker to understand a pts medical treatment plan.
Click to expand...
I agree

I've had too many medical assistants and LVNs just read the past few Rx.
 
owlegrad said:
Which diagnosis code, specifically, would have made you feel better about filling #360 Norcos? Not to be a dick but I have never understood what having a diagnosis code would do for someone. I guess you can check to make sure the code is something pain related, but it is bound to be, right? I never understood the fascination with diagnosis codes.

No one can tell you if you made the right call to dispense that many. I will say I have many times, but that I am also glad to be out of retail and having to make those kinds of judgement calls.
Click to expand...

Oh wow, are you actually serious right now? Please don’t corrupt the mind of a young new grad. It’s fine if you want to be negligent, but don’t drag others down with you. No wonder Florida has such a huge problem in this area, even someone as law abiding as you don’t even care...

When you see a high quantity narcotic rx, you absolutely should get a diagnosis code/progress note. How do you know if it’s appropriate therapy if you don’t? Here are a few examples for you:

1) A pt comes in with rx for #120 Norco written by a PA... turns out the pt only had an acute case of gallstone. How about we -100 from that rx and go from there?

2) A pt getting high quantity narcotics for a couple years... diagnosis code was for some bullsh* generalized pain... um you better send me that progress note... in the end, worked with MD and pt to get pt into a treatment facility to get clean.

3) a pt getting 30tabs of norco every week for years without any change... called md to see exactly what’s going on. Another doctor at the office answered, the progress note literally said for addiction lol pt took his business elsewhere.

4) unlike some of you out there, I was questioned by 5 DEA agents before (long story). They literally asked me if I document diagnosis to see if the therapy is appropriate.

To OP, don’t just blindly accept any diagnosis the prescribers give you. Really focus on the treatment plan, see if it’s actually right for the patient.
 
wucool33 said:
Oh wow, are you actually serious right now? Please don’t corrupt the mind of a young new grad. It’s fine if you want to be negligent, but don’t drag others down with you. No wonder Florida has such a huge problem in this area, even someone as law abiding as you don’t even care...

When you see a high quantity narcotic rx, you absolutely should get a diagnosis code/progress note. How do you know if it’s appropriate therapy if you don’t? Here are a few examples for you:

1) A pt comes in with rx for #120 Norco written by a PA... turns out the pt only had an acute case of gallstone. How about we -100 from that rx and go from there?

2) A pt getting high quantity narcotics for a couple years... diagnosis code was for some bullsh* generalized pain... um you better send me that progress note... in the end, worked with MD and pt to get pt into a treatment facility to get clean.

3) a pt getting 30tabs of norco every week for years without any change... called md to see exactly what’s going on. Another doctor at the office answered, the progress note literally said for addiction lol pt took his business elsewhere.

4) unlike some of you out there, I was questioned by 5 DEA agents before (long story). They literally asked me if I document diagnosis to see if the therapy is appropriate.

To OP, don’t just blindly accept any diagnosis the prescribers give you. Really focus on the treatment plan, see if it’s actually right for the patient.
Click to expand...
Get off your high horse.


People who get a diagnosis code for "fibromyalgia" or "lower back pain" and a chart they can't possibly interpret, then fill inappropriate prescriptions anyway are a joke.

If it's a bad script, there isn't a diagnosis code to make it ok
 
Once again this is why pharmacists think they are overworked.

Until laws are put in place, there is nothing a pharmacist can do to stop patients from getting their pain meds. Well I guess you can report every doctor, that seems to be everyone's answer.

Do people seriously think taking 4 norcos a day is causing people more harm then good?

And no I'm not saying fill everything. Stick to the serious meds and obscene doses.
 
CetiAlphaFive said:
Get off your high horse.


People who get a diagnosis code for "fibromyalgia" or "lower back pain" and a chart they can't possibly interpret, then fill inappropriate prescriptions anyway are a joke.

If it's a bad script, there isn't a diagnosis code to make it ok
Click to expand...

Then don’t be one of those people that fill inappropriate prescriptions. It’s frustrating for me to get a diagnosis like “lower back pain” and then looking at the pt’s history to see how he went from low dose/low qty norco all the way to high qty oxycodone 30mg in a short period of time. None were ever verified before I called. You don’t have to understand every treatment plan, but at least make an effort to try. It’s frustrating to read how some people think it’s a joke to even get a diagnosis code. Saving one patient is better than none. This has nothing to do with being holier than thou... simply trying to save a new grad from being led down the wrong path.

Also, as another poster mentioned, it’s for your own protection as well.
 
I was floating at chain a couple weeks ago and a pt brought in a script for (soma,fentanyl,norco) with high quantities for each, and upon looking at the patients profile I saw that they were getting it for quite a while. I said to myself this must be a cancer pt or something severe to be needing these meds, as the patient was waiting to get her meds she kept saying "I need them I feel like I'm gonna die." I decided to call the MD office to get a dx code, I was shocked it was for pinky pain and lumbar pain, written by an NP also. I ended up turning her down and telling her to come back when the usual staffer is on duty cuz I didn't feel comfortable fillling it. What I learned from that day was doesn't matter how long the pt has been getting there controls from that pharmacy or even though you might think that the pharmacists that have been verifying the scripts all this time must of got a dx code for a legitimate reason to been giving this combo of meds, think again.
 
pharmacisttotherescue said:
I was floating at chain a couple weeks ago and a pt brought in a script for (soma,fentanyl,norco) with high quantities for each, and upon looking at the patients profile I saw that they were getting it for quite a while. I said to myself this must be a cancer pt or something severe to be needing these meds, as the patient was waiting to get her meds she kept saying "I need them I feel like I'm gonna die." I decided to call the MD office to get a dx code, I was shocked it was for pinky pain and lumbar pain, written by an NP also. I ended up turning her down and telling her to come back when the usual staffer is on duty cuz I didn't feel comfortable fillling it. What I learned from that day was doesn't matter how long the pt has been getting there controls from that pharmacy or even though you might think that the pharmacists that have been verifying the scripts all this time must of got a dx code for a legitimate reason to been giving this combo of meds, think again.
Click to expand...

This I will say is acceptable to call on.
 
wucool33 said:
Then don’t be one of those people that fill inappropriate prescriptions. It’s frustrating for me to get a diagnosis like “lower back pain” and then looking at the pt’s history to see how he went from low dose/low qty norco all the way to high qty oxycodone 30mg in a short period of time. None were ever verified before I called. You don’t have to understand every treatment plan, but at least make an effort to try. It’s frustrating to read how some people think it’s a joke to even get a diagnosis code. Saving one patient is better than none. This has nothing to do with being holier than thou... simply trying to save a new grad from being led down the wrong path.

Also, as another poster mentioned, it’s for your own protection as well.
Click to expand...


A diagnosis code alone is worthless.

A good note and documentation doesn't need a diagnosis code.

Therefore, the codes are worthless
 
Sorry I think I was unclear. What I meant was I don’t understand the purpose of getting just a diagnosis code. I would say 99 percent of the time it’s so little information that it’s pointless. Perhaps I am mistaken but I really doubt just getting a diagnosis code is going to cover any liability from inappropriate dispensing.

I definitely did not mean to imply that we should forgo doing our corresponding due diligence. I just don’t think diagnosis codes play a very large role or practically any role at all in that corresponding responsibility.

But by all means if it makes you feel better to speak to a receptionist and get a few digit codes for his lower back pain by all means go for it. Personally I just never found it reassuring.
 
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wucool33 said:
Oh wow, are you actually serious right now? Please don’t corrupt the mind of a young new grad. It’s fine if you want to be negligent, but don’t drag others down with you. No wonder Florida has such a huge problem in this area, even someone as law abiding as you don’t even care...

When you see a high quantity narcotic rx, you absolutely should get a diagnosis code/progress note. How do you know if it’s appropriate therapy if you don’t? Here are a few examples for you:

1) A pt comes in with rx for #120 Norco written by a PA... turns out the pt only had an acute case of gallstone. How about we -100 from that rx and go from there?

2) A pt getting high quantity narcotics for a couple years... diagnosis code was for some bullsh* generalized pain... um you better send me that progress note... in the end, worked with MD and pt to get pt into a treatment facility to get clean.

3) a pt getting 30tabs of norco every week for years without any change... called md to see exactly what’s going on. Another doctor at the office answered, the progress note literally said for addiction lol pt took his business elsewhere.

4) unlike some of you out there, I was questioned by 5 DEA agents before (long story). They literally asked me if I document diagnosis to see if the therapy is appropriate.

To OP, don’t just blindly accept any diagnosis the prescribers give you. Really focus on the treatment plan, see if it’s actually right for the patient.
Click to expand...

This is an excellent example of the responsible practice of pharmacy. In pretty much all of your examples the issue wasn't resolved by getting a diagnosis code, it was solved by getting a complete picture of what was going on. That is what I meant. OP is concerned that he didn't get a diagnosis code, but I would bet any amount of money that the diagnosis code would have been something related to pain. I can't wrap my head around that being helpful. Your advice is spot on though - get a complete picture of what is really going on and go from there. Even that is easier said then done, but it is the responsible thing to do.

#2 is pretty incredible. Congratulations on that.
 
Um why exactly was this patient not sent back to the office for a new script? I would consider it likely that the md intended to taper the dose, so if that is not the case why can't the office fix their own mistake themselves?
 
CetiAlphaFive said:
Get off your high horse.


People who get a diagnosis code for "fibromyalgia" or "lower back pain" and a chart they can't possibly interpret, then fill inappropriate prescriptions anyway are a joke.

If it's a bad script, there isn't a diagnosis code to make it ok
Click to expand...

not much for reading comprehension there huh lol
 
wucool33 said:
Oh wow, are you actually serious right now? Please don’t corrupt the mind of a young new grad. It’s fine if you want to be negligent, but don’t drag others down with you. No wonder Florida has such a huge problem in this area, even someone as law abiding as you don’t even care...

When you see a high quantity narcotic rx, you absolutely should get a diagnosis code/progress note. How do you know if it’s appropriate therapy if you don’t? Here are a few examples for you:

1) A pt comes in with rx for #120 Norco written by a PA... turns out the pt only had an acute case of gallstone. How about we -100 from that rx and go from there?

2) A pt getting high quantity narcotics for a couple years... diagnosis code was for some bullsh* generalized pain... um you better send me that progress note... in the end, worked with MD and pt to get pt into a treatment facility to get clean.

3) a pt getting 30tabs of norco every week for years without any change... called md to see exactly what’s going on. Another doctor at the office answered, the progress note literally said for addiction lol pt took his business elsewhere.

4) unlike some of you out there, I was questioned by 5 DEA agents before (long story). They literally asked me if I document diagnosis to see if the therapy is appropriate.

To OP, don’t just blindly accept any diagnosis the prescribers give you. Really focus on the treatment plan, see if it’s actually right for the patient.
Click to expand...

I almost **** myself. The progress note legit said "addiction"??????? Do they not realize it's a crime and illegal to knowingly prescribe a narcotic for an addiction diagnosis and maintaining that? I swear some of these prescribers are naive as all get out and should be required to take a MPJE of sorts for their licensure.
 
Deja said:
not much for reading comprehension there huh lol
Click to expand...

Nice meme.

Are you talking about mind reading, or what point do you think you're making?
He said, and i quote, "don't drag others down with you"
On planet Earth, we use the phrase "get off your high horse" to indicate that we think someone is being condescending.

I apologise if you thought that i was discussing actual horses.
The idea of diagnosis codes mattering is one of those things perpetuated by bad pharmacists that accept every corporate memo as law.
They are insignificant, meaningless, and a waste of time.

Either write a good note or don't.

The words Diagnosis Code have never appeared anywhere in any Pharmacy laws or disciplinary action related to inappropriate prescribing or corresponding liability.
Ever.
They're worthless corporate crap.

In the future, when you disagree with someone's point, try to address it and refute it with an actual counter point.
 
Last edited:
Digsbe said:
I almost **** myself. The progress note legit said "addiction"??????? Do they not realize it's a crime and illegal to knowingly prescribe a narcotic for an addiction diagnosis and maintaining that? I swear some of these prescribers are naive as all get out and should be required to take a MPJE of sorts for their licensure.
Click to expand...

The covering physician said, "yeahhhhhh, I'm not sure if this is right."

I also had an old lady bringing in an rx for norco that literally had "For opioid addiction management" printed on the bottom of the rx... and get this, it filled before with no questions asked. smh
 
CetiAlphaFive said:
Nice meme.

Are you talking about mind reading, or what point do you think you're making?
He said, and i quote, "don't drag others down with you"
On planet Earth, we use the phrase "get off your high horse" to indicate that we think someone is being condescending.

I apologise if you thought that i was discussing actual horses.
The idea of diagnosis codes mattering is one of those things perpetuated by bad pharmacists that accept every corporate memo as law.
They are insignificant, meaningless, and a waste of time.

Either write a good note or don't.

The words Diagnosis Code have never appeared anywhere in any Pharmacy laws or disciplinary action related to inappropriate prescribing or corresponding liability.
Ever.
They're worthless corporate crap.

In the future, when you disagree with someone's point, try to address it and refute it with an actual counter point.
Click to expand...

I literally provided you with examples where a diagnosis was all you needed in order to know if a prescription was appropriate or not... but ok...

I'll admit I was a little frustrated when I was reading all the dismissive comments about calling the doctor to get a diagnosis, but I'm sure everyone here would agree that you have been the most condescending poster on this forum since you started posting regularly.
 
We are allowed to fill a 90 day supply for a C2 in California?
 
wucool33 said:
I literally provided you with examples where a diagnosis was all you needed in order to know if a prescription was appropriate or not... but ok...

I'll admit I was a little frustrated when I was reading all the dismissive comments about calling the doctor to get a diagnosis, but I'm sure everyone here would agree that you have been the most condescending poster on this forum since you started posting regularly.
Click to expand...
So go ahead and tell me to get off of my high horse if there's anything i post what you ever disagree with.

You don't need everyone here to agree with you.
You're an adult.

I'm happy that you somehow had 5 field agents all in the same place somehow (was it El Chapo trying to get an Rx filled?) and that they affirmed the importance of Diagnosis codes for you.

I think the problem is that i understood Owle's post correctly to mean that there's nothing special about a code while you somehow thought that he meant pharmacists should not call the doctor at all.

I'm honestly baffled as to how you arrived at that conclusion.

Anyway, i also think you need to understand that my criticism of diagnosis codes isn't a criticism of everything you wrote.

The fact that part of my post agrees with your post should probably be a hint for you.
 
wucool33 said:
I literally provided you with examples where a diagnosis was all you needed in order to know if a prescription was appropriate or not... but ok...

I'll admit I was a little frustrated when I was reading all the dismissive comments about calling the doctor to get a diagnosis, but I'm sure everyone here would agree that you have been the most condescending poster on this forum since you started posting regularly.
Click to expand...

Ha, those are some big words. He is abrasive, no doubt, but if you step back his posts are quite entertaining. Well, that's my opinion anyway.
 
CetiAlphaFive said:
So go ahead and tell me to get off of my high horse if there's anything i post what you ever disagree with.

You don't need everyone here to agree with you.
You're an adult.

I'm happy that you somehow had 5 field agents all in the same place somehow (was it El Chapo trying to get an Rx filled?) and that they affirmed the importance of Diagnosis codes for you.

I think the problem is that i understood Owle's post correctly to mean that there's nothing special about a code while you somehow thought that he meant pharmacists should not call the doctor at all.

I'm honestly baffled as to how you arrived at that conclusion.

Anyway, i also think you need to understand that my criticism of diagnosis codes isn't a criticism of everything you wrote.

The fact that part of my post agrees with your post should probably be a hint for you.
Click to expand...

It was literally 5 agents taking me to a back room... it was a crazy experience. I think I still have one of their business cards.

I think we are pretty much all on the same page now, so there’s no need for me to comment further lol
 
owlegrad said:
Ha, those are some big words. He is abrasive, no doubt, but if you step back his posts are quite entertaining. Well, that's my opinion anyway.
Click to expand...

I think I said it before in another thread, his posts can be entertaining/useful some times lol
 
CetiAlphaFive said:
Nice meme.

Are you talking about mind reading, or what point do you think you're making?
He said, and i quote, "don't drag others down with you"
On planet Earth, we use the phrase "get off your high horse" to indicate that we think someone is being condescending.

I apologise if you thought that i was discussing actual horses.
The idea of diagnosis codes mattering is one of those things perpetuated by bad pharmacists that accept every corporate memo as law.
They are insignificant, meaningless, and a waste of time.

Either write a good note or don't.

The words Diagnosis Code have never appeared anywhere in any Pharmacy laws or disciplinary action related to inappropriate prescribing or corresponding liability.
Ever.
They're worthless corporate crap.

In the future, when you disagree with someone's point, try to address it and refute it with an actual counter point.
Click to expand...

well considering his post wasn't about just diagnosis codes, idk what you are on about... seems to me you are still having trouble comprehending his post
 
Deja said:
well considering his post wasn't about just diagnosis codes, idk what you are on about... seems to me you are still having trouble comprehending his post
Click to expand...

So Owle makes a post that gets misunderstood, which gets a reply which i then supposedly "misunderstand" as condescending and reply to, and now you're here to clarify it with an 8 word meme written in broken English.

Congrats.
 
wucool33 said:
It was literally 5 agents taking me to a back room... it was a crazy experience. I think I still have one of their business cards.

I think we are pretty much all on the same page now, so there’s no need for me to comment further lol
Click to expand...

To be fair... I am the best
 
wucool33 said:
Oh wow, are you actually serious right now? Please don’t corrupt the mind of a young new grad. It’s fine if you want to be negligent, but don’t drag others down with you. No wonder Florida has such a huge problem in this area, even someone as law abiding as you don’t even care...

When you see a high quantity narcotic rx, you absolutely should get a diagnosis code/progress note. How do you know if it’s appropriate therapy if you don’t? Here are a few examples for you:

1) A pt comes in with rx for #120 Norco written by a PA... turns out the pt only had an acute case of gallstone. How about we -100 from that rx and go from there?

2) A pt getting high quantity narcotics for a couple years... diagnosis code was for some bullsh* generalized pain... um you better send me that progress note... in the end, worked with MD and pt to get pt into a treatment facility to get clean.

3) a pt getting 30tabs of norco every week for years without any change... called md to see exactly what’s going on. Another doctor at the office answered, the progress note literally said for addiction lol pt took his business elsewhere.

4) unlike some of you out there, I was questioned by 5 DEA agents before (long story). They literally asked me if I document diagnosis to see if the therapy is appropriate.

To OP, don’t just blindly accept any diagnosis the prescribers give you. Really focus on the treatment plan, see if it’s actually right for the patient.
Click to expand...
You are absolutely correct, I work for a major PBM and with all opioids the insurance will allow a 7 day supply of the medication- in order to get a greater length of therapy, the MD must complete a criteria form in which they must have a DX code that justify the qty and duration of therapy (i.e Cancer patient, undergoing surgery, chronic injury, etc) so Diagnosis code are surely something you want to document.
 
CetiAlphaFive said:
So Owle makes a post that gets misunderstood, which gets a reply which i then supposedly "misunderstand" as condescending and reply to, and now you're here to clarify it with an 8 word meme written in broken English.

Congrats.
Click to expand...
speaking of broken English lol
 
Deja said:
speaking of broken English lol
Click to expand...

I'd ask you to explain what's wrong with the sentence, besides verbosity, if i thought you were capable of actually articulating it.
 
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