Coding for Opiate Dependence

Tufts Health Plan is working with providers to improve the diagnosis and treatment of substance abuse. In support of this effort, it is essential that we obtain accurate data to document substance abuse among our members. Correct diagnostic coding allows us to obtain more accurate information and arrange appropriate substance abuse services.

It is important for the member’s protection and the integrity and accuracy of the member’s medical record that the most accurate diagnosis code is used when coding for opiate dependence. Diagnosis code 304.00 (opioid type dependence) indicates dependence that is the result of substance abuse. However, if opiate dependence is not substance abuse, such as when a patient is on a maintenance program for pain management, diagnosis code V58.69 (long term [current] drug use) is the appropriate code for a secondary diagnosis rather than 304.00.

NCQA Standard for Follow-Up Care
A National Committee for Quality Assurance (NCQA) clinical standard measures follow-up visits for members identified with a substance abuse diagnosis. We believe this standard makes good clinical sense, and we are working to educate members and providers about the importance of substance abuse follow-up care.

In addition, Tufts Health Plan has adopted the American Psychiatric Association's practice guideline for the Treatment of Patients with Substance Use Disorders.

May 1, 2010