UDS for lyrica/pregabalin

[Dansk2011]

Being told that I need to UDS for patients that I am only prescribing lyrica/pregabalin to. I don't feel comfortable with it and not sure I see the value. Anyone typically UDS for these patients?

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[willabeast]

Being told that I need to UDS for patients that I am only prescribing lyrica/pregabalin to. I don't feel comfortable with it and not sure I see the value. Anyone typically UDS for these patients?

DO they require UDS for gabapentin? If not, i sense someone being sneaky.

 

[lobelsteve]

I wouldnt get uds for neuropathics.

 

[callmeanesthesia]

Being told that I need to UDS for patients that I am only prescribing lyrica/pregabalin to. I don't feel comfortable with it and not sure I see the value. Anyone typically UDS for these patients?

Told by the UDS companies?

 

[lobelsteve]

Must own the UDS

 

[SommeRiver]

I refuse

 

[deleted875186]

Makes no sense to me.

 

[jsaul]

lyrica is a controlled substance so the boss may see it that way

 

[Orin]

It does risk stratify them for a sedating controlled substance. With the recent concerns with gabapentinoids from the FDA, it's probably safer to at least CYA test. I might push back to ensure you aren't doing the same level of testing for those agents as you are for full-agonist opioids, but that's just splitting hairs.

 

[10KHertz]

There is a phenomenon of gapapentanoid addiction. Rare. I don’t screen , but I would if atypical escalation or usage. Don’t just dismiss this possibility...

 

[Agast]

No clinical benefit and no legal benefit

 

[Ducttape]

You may want to consider uDS for lyrica as it is a controlled substance but not for gabapentin.

probably will never be an issue in terms of state or federal oversight.
At most, I do simple tox screen for illicits, maybe once a year. But then I don’t do a lot of lyrica because I don’t find it really makes any difference for those who don’t tolerate gabapentin.

 

[Status Sciaticus]

Does it make sense to use these UDS as a means to ensure that they are adhering to medical therapy before going up to opioids/procedures?

 

[10KHertz]

You may want to consider uDS for lyrica as it is a controlled substance but not for gabapentin.

probably will never be an issue in terms of state or federal oversight.
At most, I do simple tox screen for illicits, maybe once a year. But then I don’t do a lot of lyrica because I don’t find it really makes any difference for those who don’t tolerate gabapentin.

Rumor is that gabapentin is going controlled soon. What a headache...

 

[lobelsteve]

Would you ask for UDS for all of those Ambien/Lunesta patients? How about Provigil?

Money grab. More amazing is that BZD are in same schedule as Ambien and Ultram.

 

[Ducttape]

I don't prescribe those agents.

if I have to use my DEA number to prescribe a medication, then I get a UDS.

also, if I have to look at a PMP to prescribe a medication, I get a UDS.

fwiw, I'm employed. I don't get any money for ordering a UDS. not a money grab.

 

[lobelsteve]

I don't prescribe those agents.

if I have to use my DEA number to prescribe a medication, then I get a UDS.

also, if I have to look at a PMP to prescribe a medication, I get a UDS.

fwiw, I'm employed. I don't get any money for ordering a UDS. not a money grab.

So you do not Rx, but then you tell people how to check PDMP for drug you do not Rx?

Opiates, BZD, stimulant meds all need to be checked on PDMP. Other medications are not necessary.

And Ducttape: How much did the DEA pay you last year?

 

[Ducttape]

they "pay" me with the continued ability for me to prescribe controlled substances.


please refresh my memory where I specifically told someone they had to check a PMP or a UDS or I would come down on them. clearly, whether one wants to follow the rules is on them, and what I say doesn't matter in the end.

on this thread, I gave a suggestion and stated what I do.


and in that line, in my state, you have to check a PMP on all controlled substances, whether that is Schedule II or V. including ambien.

 

[10KHertz]

Steve what are UDS paying in office ? After the major reform in UDS reimbursement (maybe 5 years ago, due to overutilization abuse ) , I get $19 for all the headaches involved in screening. I don’t screen for neuropathic Meds unless there’s a concern in usage. So I don’t necessarily mind peeps over screening on controlled substances , even schedule 5. We are being forced to do it really.

 

[Ferrismonk]

You still get a lot of money for the confirmatory LC/MS UDS I believe. In office UDS doesn't pay much.

I don't know of any guidelines to test UDS when writing controlled substances, just opiates.

In general, one should only order a test if the results are going to change the treatment plan.

That being said, PCPs have been encouraged to UDS everyone since drug use/abuse is a major health problem.

 

[lobelsteve]

Steve what are UDS paying in office ? After the major reform in UDS reimbursement (maybe 5 years ago, due to overutilization abuse ) , I get $19 for all the headaches involved in screening. I don’t screen for neuropathic Meds unless there’s a concern in usage. So I don’t necessarily mind peeps over screening on controlled substances , even schedule 5. We are being forced to do it really.

My UDS is done by Quest or Labcorp through a hospital lab. They pay nothing to me or my service line.

 

[PinchandBurn]

Would you ask for UDS for all of those Ambien/Lunesta patients? How about Provigil?

Money grab. More amazing is that BZD are in same schedule as Ambien and Ultram.

Lyrica. Its a controlled substance. Gabapentin isn't.

I dont own a lab or get paid for labs.

But if its a controlled substance I do occasional UDs. I also have them sign a controlles substance/opioid agreement. Overkill? Perhaps, but cya.

 

[Ferrismonk]

In my state, gabapentin is controlled.

 

[Ronin1]

For you guys on wrvu do you get any units for uds interpretation? How about minimal sedation? I’m sure the hopd is billing for it

 

[Ducttape]

nope.

 

[BobBarker]

For you guys on wrvu do you get any units for uds interpretation? How about minimal sedation? I’m sure the hopd is billing for it

Yes. They are very small but add up over a year.

 

[mariajane]

Overkill for $ure.

My employer has a brainless minion assistant who places a UDT on every third patient appt (generally every 3 months). Doesnt matter if we prescribe the patient ANY medication of ANY KIND or not, they get a urine. So I, while dramatically rolling my eyes, diligently cancel udt’s on any patients we write no controlled meds for...if lyrica, i let it slide but no more than once a year. It’s a delightful moneymaker. Meanwhile, some of the patients are getting handed $600 laboratory bills. But that’s ok, we can just send it to collections along with the thousands-of-dollars-bill for the multiple mbb’s (that were unnecessarily separated out to get maximal number of procedures) and subsequent failed RF’s that we (clarify: not me) also did on this unsuspecting patient....so it all works out. Cheer$.

 

[cowboydoc]

For you guys on wrvu do you get any units for uds interpretation? How about minimal sedation? I’m sure the hopd is billing for it

NO for UDS, Yes for sedation... 0.25 wRVU or about $16. Yet another reason to rarely use sedation.

 

[BobBarker]

.25 sedation, .17 Uds

 

[bedrock]

In my state, gabapentin is controlled.

Silly

 

[SommeRiver]

How in the world do you bill for UDS result interpretation?

 

[Keona]

Silly

My state as well. I get a Uds once a year on my patients with diabetic neuropathy. Basically it’s just annoying to deal with. If I have to fill out a controlled substance script I get at least an annual urine drug screen per our state recommendations. Then the patient and I both discuss the “government”.

 

[Laryngospasm]

Overkill for $ure.

My employer has a brainless minion assistant who places a UDT on every third patient appt (generally every 3 months). Doesnt matter if we prescribe the patient ANY medication of ANY KIND or not, they get a urine. So I, while dramatically rolling my eyes, diligently cancel udt’s on any patients we write no controlled meds for...if lyrica, i let it slide but no more than once a year. It’s a delightful moneymaker. Meanwhile, some of the patients are getting handed $600 laboratory bills. But that’s ok, we can just send it to collections along with the thousands-of-dollars-bill for the multiple mbb’s (that were unnecessarily separated out to get maximal number of procedures) and subsequent failed RF’s that we (clarify: not me) also did on this unsuspecting patient....so it all works out. Cheer$.

Sounds like you work at a pretty bad place.. why don’t you find a job that is better?

 

[mariajane]

Sounds like you work at a pretty bad place.. why do t you leave?

I’m a lowly NP. In my experiences thus far, greed is everywhere. And the other pain clinics in my area have far worse reputations....sad but true! I personally practice as ethically as I can.

 

[NOSfan]

lyrica is a controlled substance so the boss may see it that way

Going to open a GC/MS company and start running UDT for Testosterone on all my male patients

 

[BobBarker]

It is not medically necessary and would
not hold up well in court.