2019 Medicare Part D Opioid Policies: Training Materials

Improving Drug Utilization Review Controls in Part D

Effective January 1, 2019, CMS announced new strategies to further help Medicare Part D sponsors prevent and combat opioid overuse including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention.

As of Dec 15 2018, the web page is found here:

https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html

Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

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Guidelines for HIV coding

Chapter 1: Certain Infectious and Parasitic diseases (A00-B99) Human Immunodeficiency virus (HIV) Infections B20 Human immunodeficiency virus (HIV) disease (symptomatic) R75 Inconclusive laboratory evidence of human immunodeficiency virus (HIV) Z20.6 Contact with and exposure to human immunodeficiency virus (HIV) Z11.4 Encounter for screening for human immunodeficiency virus (HIV) Z71.7 human immunodeficiency virus [HIV] counseling Z21 Asymptomatic human immunodeficiency virus (HIV) infection status “Confirmation” does NOT require documentation for positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive, or has an HIV-related illness is sufficient. Once a patient is diagnosed with B20, they should never be assigned R75 or Z21. Sequencing of HIV Codes B20 should be sequenced as the first-listed diagnosis when patient is treated for an HIV related condition. Any non-related conditions get sequenced followi...

Preliminary ICD-10-CM CMS HCC Mappings

The link below take you to the Preliminary ICD-10-CM Codes, CMS-HCC and RxHCC Models, Includes FY2014 preliminary list of ICD-10 codes HCC Mappings from CMS. Last modified 9/30/2014. Preliminary ICD-10-CM Mappings Diagnosis Code Description CMS-HCC PACE/ESRD Model Category V21 CMS-HCC Model Category V22 (clinically revised model implemented in 2014) RxHCC Model Category V04 CMS-HCC PACE/ESRD Model for 2015 Payment Year CMS-HCC Model for 2015 Payment Year RxHCC Model for 2015 Payment Year #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #MedicalCoding #Mappings Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to s...

Major Depressive Disorder

Major depressive disorder According to the American Psychiatric Association, major depressive disorder can be seen in patients who have suffered a depressive episode lasting at least two weeks, as manifested by at least five of the following symptoms: depressed mood, loss of interest or pleasure in most or all activities, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicidal ideation. Major depression is highly recurrent, with recurrent episodes occurring in 50% or more of patients. Remission and recovery from major depression Whether or not a patient is being treated for depression (e.g., counseling and/or medication), remission can be defined as a level of depressive symptoms basically indistinguishable from that in someone who has never been depressed. When reporting history of major depressive disorder, instead of coding V1...

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