What Does ICD-10 Have to Do With Prescriptions to Treat Acute Pain?

We’re just days away from ICD-10 2018 implementation. One group with ICD-10-CM on the brain may be Ohio pharmacists.

Here’s why: Effective Dec. 29, 2017, there will be new rules in Ohio for prescribing opioids. One of the requirements is for the prescription to include “The ICD-10-CM medical diagnosis code of the primary disease or condition that the controlled substance is being used to treat.” The code is one more step in proving the prescription is for a legitimate medical purpose.

Know That 4 Characters Is OK

Interestingly, the code included on the prescription needs to provide only the first four characters of the ICD-10 code. The complete code is fine, but the minimum of four is acceptable.

The example given in the rule is M16.5 (Unilateral post-traumatic osteoarthritis of hip). If you were reporting this diagnosis on a claim, you would need one more character to make it complete. The final character of this code identifies the side.

Here are some additional examples, given by the State of Ohio Board of Pharmacy, that you may see on a prescription under this rule:

  • S88.0 (Traumatic amputation at knee level)
    • To report S88.0- on a claim, you would need to report seven characters.
  • G89.3 (Neoplasm related pain (acute) (chronic))
    • This code is complete with four characters.
  • S52.5 (Fracture of lower end of radius)
    • To report S52.5- on a claim, you would need to report seven characters.

What If the Provider Forgets the Code?

The prescription should include the diagnosis code, but there are instructions if it doesn’t. The rule says that the pharmacist may add or change the ICD-10 code only after consulting with and getting the agreement of the prescriber (or agent of the prescriber).

Additionally, pharmacists can dispense the prescription without the diagnosis code, according to the State of Ohio Board of Pharmacy. In those cases when a code is not included, the pharmacist will indicate “NC” when reporting to OARRS (Ohio Automated Rx Reporting System).

Keep an Eye on Future Developments

The plan is for the requirement to take effect for all other controlled substance prescriptions June 1, 2018. This would include substances that treat conditions such as ADD, low testosterone, narcolepsy, and seizure disorders.

What About You?

What’s your opinion on this rule? Do you have any more helpful information about it to share?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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