Diagnosis Code

[mimi06bg]

Hey everyone,
So, we had a pharmacist call the doctor's office to ask for a diagnosis code on a pain medication. Apparently, the nurse was very upset with the questioning and wouldn't provide him with the information, stating "you can look it up, we don't have time for this." I think this was a valid question and the pharmacist had every right to request such information. What's you intake on this?

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[npage148]

I had an er discharge a script for a part b patient for a walker at closing. Couldn't get me an icd-10 code. Flabbergasted I needed it and barely tried to help. Sent away an angry patient

 

[RxRetailRx]

I need Dx ( does not has to be diagnosis code, sometimes just document the diagnosis ) for fill Oxycodone, hydromorphone, methadone as such, most of time I had no problem to get them from Dr's office, but only denied once by one doctor bcz he think that would be HIPAA violation if he give away the Dx......just tell them this is company policy, you can provide it or patient have to go somewhere else.

 

[LoveWillSaveTheDay]

I say "it's for insurance purposes and I'd rather not commit insurance fraud by writing any DX code I feel is appropriate." If I get no where after that, I make the patient fully aware that it's their doctors/nurses fault.

 

[zelman]

Hey everyone,
So, we had a pharmacist call the doctor's office to ask for a diagnosis code on a pain medication. Apparently, the nurse was very upset with the questioning and wouldn't provide him with the information, stating "you can look it up, we don't have time for this." I think this was a valid question and the pharmacist had every right to request such information. What's you intake on this?

Wait. A nurse at a doctor's office didn't want to do her job?! Bizarre!

 

[Sine Cura]

How do you look up medical records you don't have?

Don't take the script because you were not able to confirm the controlled substance Rx was issued for a legitimate medical purpose, and part of that legal responsibility is obtaining information to confirm it. Disclosure of such information between covered entities does not violate the Privacy Rule.

Of course if everything is M54.5 or G89.4 that itself could be considered suspicious in the eyes of DEA...

 

[ericn2k3]

It is policy at our store to document dx for narcotics qty > 100 and/or repeated monthly fill. We tell them its a one time thing. We also required as driver license with every fill. Majority of the surrounding office have no problem disclosing the info.

 

[Dr Wario]

I am really curious how other pharmacists are handling the recent cdc guidelines that strongly cautions against opiate doses of > 90 morphine equivalents per day. Most of the doctors I have talked to about this stated that their patient has been on their current dose (usually > 200 MEUs/day) and they see no reason to change it regardless of recommendations. I recently inherited a store that has several customers well above the guideline and I have been speaking with their prescribers expecting that doses be reduced by at least 10% per month until they are within guidelines or they have MASSIVELY extenuating circumstances that necessitate ultra high doses (and sorry PA/NP, telling me that they have been on that dose "forever" is not a valid excuse").

How have other pharmacists handled these patients? Perhaps many of you did not allow these types of customers in the first place, but for those of you have them, did these guidelines change your dispensing practices in any way? Before these guidelines, high opiate doses were fairly vague, now that we have a number, what kind of justifications do you expect from prescribers?

https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf

 

[npage148]

I don't have to worry about it any more. Maine has put a limit of 100/day with very narrow exceptions (cancer with an exp date, hospice, etc) and require iced-10s. After so much bitching from people it definately curtained doctors in my area. It's great