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Sep 30 2017

Resource Center: Buprenorphine treatment for heroin addiction #treatments #for #heroin #addiction


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Resource Center: Buprenorphine treatment for heroin addiction

Coding is either based on complexity of service or time. with four contributing components:

  • history
  • physical exam
  • complexity of decision-making
  • contributing factors (eg: time)

In the event of an audit, the documentation for a single visit must stand alone, unless another record is specifically referenced.

The most commonly used CPT codes by Primary Care Physicians are as follows:

Assessment Visit:
Comprehensive evaluation of new patient or established patient for suitableness for buprenorphine treatment

New Patient E/M: 99201, 99202, 99203, 99204, 99205*

Est. Patient E/M: 99211, 99212, 99213, 99214, 99215*

Induction Visits:
Any of the new patient evaluation and management codes might be used for maintenance visits. Codes listed are in order of increasing length of time with patient and/or severity of the problems.

Prolonged visit codes (99354, 99355) may also be added onto E/M codes for services that extend beyond the typical service time, with or without face-to-face patient contact. Time spent need not be continuous.

New Patient E/M: 99201, 99202, 99203, 99204, 99205*

Est. Patient E/M: 99211, 99212, 99213, 99214, 99215*

Add-on Codes: 99354: 30-60 minutes
99355: each additional 30 minutes

Maintenance Visits:
Any of these established patient E/M codes might be used for maintenance visits.

Counseling codes are commonly used to bill for maintenance visits, since since counseling and coordinating service with addiction specialists comprise the majority of these follow-up visits.

See the following page on counseling for more detailed information on how to bill for these visits.

99211, 99212, 992213

Some private health insurers are developing standard billing codes for buprenorphine treatment services. For instance, Cigna tells clinicians to use the HCPCS code for “unspecified mental health care” for buprenorphine-related visits. The code is H0033 – Oral Medication Administration, Direct Observation. Cigna allows for approximately $300 reimbursement for the induction visit.

*Note: All 5 levels are included in this table, however, level 5 (99205, 99215) is infrequently used in primary care and typically involves problems of moderate to high severity.

Ofrece información a los pacientes sobre la buprenorfina y los tratamientos con ayuda de medicamentos para tratar la adicción a los opioides, y también decribe la adicción y los síntomas del síndrome de abstinencia. Además, explica cómo funciona la buprenorfina, su uso apropiado, sus efectos secundarios y cómo se la utiliza en conjunto con la consejería en el proceso de recuperación.

Substance Abuse and Mental Health Services Administration (SAMHSA)

A reference tool used to provide clinicians with screening and treatment resources for substance use disorder within active duty and veteran populations, including resources on brief interventions and pharmacological treatment.

VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders

Commonly Used Forms:

An example of a sample agreement/contract that provides detailed explanations of patient expectations, cooperation, and involvement in their treatment plan.

Funding Information

Development of this website was funded entirely by grant #R44DA12066 and contract #HHSN271200655304C from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health . The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. Ongoing development and maintenance is funded by the training fee and Clinical Tools, Inc . No commercial support is received.

Clinical Tools, Inc. is accredited by the ACCME to provide continuing medical education for physicians.

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Unless otherwise noted, individuals pictured are models and are used for illustrative purposes only.

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This site is for educational purposes only and medical decisions should not be based solely on its content. This site, its authors, and its consultants do not assume liability for errors or omissions.


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