Urine Drug/Alcohol Testing HMO

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1 Last Review Date: October 16, 2017 Number: MG.MM.LA.42 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the patient meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request for prior authorization. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. EmblemHealth Services Company LLC, ( EmblemHealth ) has adopted the herein policy in providing management, administrative and other services to HIP Health Plan of New York, HIP Insurance Company of New York, and Group Health Incorporated, related to health benefit plans offered by these entities. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc. Skip definitions and go directly to guideline Definitions Urine drug/alcohol screening/testing is used to detect alcohol, prescription medications and illegal substances for the purpose of medical treatment. Definitive, also known as confirmatory or identification testing (involves liquid chromatography and mass spectrometry [LC-MS]) is additional testing used to verify the results of the initial drug screen. Screening and testing should focus on the detection of specific drugs and not routinely include a panel of drugs of abuse. (See Limitations/Exclusions) The two laboratory methods for measuring urine/alcohol drug levels are: 1. Immunoassay (qualitative/presumptive) testing 2. Chromatography/mass spectrometry (quantitative testing) Presumptive/Qualitative Drug Testing Presumptive" urine drug testing (UDT) Immunoassay (IA) Qualitative IA Used to determine the presence or absence of drugs or drug classes in a urine sample; results expressed as negative or positive or as a numerical result. Includes competitive immunoassays (IA) (below row) and thin layer chromatography. Used to identify the presence or absence of drug classes and some specific drugs; biochemical tests measure the presence above a cutoff level of a substance (drug) with the use of an antibody. Read by photometric technology. An IA involves an antibody that reacts best with the stimulating drug, and reacts to a lesser extent (cross-reactive) or not at all with other drugs in the drug class. While presumptive tests vary in their ability to detect illicit drugs such as tetrahydrocannabinol (THC), cocaine, 3,4-methylenedioxy-Nmethylamphetamine (MDMA; ecstasy ) and phencyclidine (PCP), they may not be optimal tests for many prescription drugs, such as opiates, barbiturates, benzodiazepines and opioids.

2 Page 2 of 23 Definitive/Quantitative/Confirmation Definitive UDT Specimen Validity Testing Point of Care Testing (POCT) Standing Orders Blanket Orders Reflex Testing Opioids Heroin Used to identify specific medications, illicit substances and metabolites; reports the results of analytes absent or present typically in concentrations such as ng/ml. Definitive methods include, but are not limited to gas chromatography coupled with mass spectrometry (GC-MS) and liquid chromatography (LC- MS) testing methods only. These high-complexity tests, used to confirm results of a presumptive test, should be performed in a CLIA (CMS-certified) accredited laboratory where national quality control standards for testing and laboratory personnel training have been established. Note: The need for quantification must be substantiated in the medical record. See Section D4, Chronic Opioid therapy for clinical criteria. Urine specimen testing to ensure that urine is consistent with normal human urine and has not been adulterated or substituted; may include, but is not limited to, ph, specific gravity, oxidants and creatinine. (See Limitations/Exclusions) Used when immediate test results are needed for the immediate management of the patient. POCT consists of an IA test method, which primarily identifies drug classes and a few specific drugs. Platform consists of cups, dipsticks, cassettes or strips; read by the human eye. (See Limitations/Exclusions) Test request for a specific patient representing repetitive testing to monitor a condition or disease for a limited number of sequential visits; individualized orders for certain patients for pre-determined tests based on historical use, risk and community trend patient profiles. Clinician can alter the standing order. Note: A profile differs from a panel in that a profile responds to the clinical risks of a particular patient, whereas a panel may encourage unnecessary or excessive testing when no clinical cause exists for many of the tests. Test request that is not for a specific patient; rather, it is an identical order for all patients in a clinician s practice without individualized decision making at every visit. (See Limitations/Exclusions) Laboratory testing that is performed "reflexively" after initial test results to identify further diagnostic information essential to patient care. (Testing performed as a step necessary to complete a physician s order is not considered reflex testing) Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin ), hydrocodone (Vicodin ), codeine, morphine, and many others. These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor s prescription). Regular use even as prescribed by a doctor can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths. An opioid overdose can be reversed with the drug naloxone when given right away Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the Asian opium poppy plant. Heroin can be a white or

3 Page 3 of 23 Fentanyl Nalaxone Suboxone brown powder, or a black sticky substance known as black tar heroin. Other common names for heroin include dope, horse, junk, and smack. Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It is a schedule II prescription drug and is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq, Duragesic and Sublimaze. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT and Tango and Cash. Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications. Suboxone (buprenorphine and naloxone) sublingual film is a partial opioid agonist indicated for treatment of opioid dependence. Note: Information regarding parent drugs and their metabolites may be found in Appendix A Guideline (Applicable to HMO members only) A. Urine drug/alcohol testing is considered medically necessary when the following criteria are met: 1. Medical record documentation substantiates that each test will impact treatment 2. If full panel screen is requested, medical record substantiates the need for a full panel (i.e., clinical rationale is provided for each of the drugs/drug classes to be screened with specific reference to any specialty test orders) 3. Documentation describes how results will impact the treatment plan (i.e., whether initial/continuation of treatment is medically reasonable based upon findings) 4. One of the following conditions is present: a. Altered mental status b. Medical/psychiatric condition where drug/alcohol toxicity may be a contributing factor c. Perinatal maternal drug use (e.g. current pregnancy with possible exposure of the fetus to illicit drugs taken by the mother, or history of recent delivery of infant diagnosed with Neonatal Abstinence/ Neonatal Withdrawal Syndrome) d. Need to assess adherence to prescribed medications e. Need to assess and treat members with substance abuse disorders including alcohol 5. Drug confirmation is indicated if: a. Qualitative screening is positive i. Will only cover the drug class represented by the positive screening ii. Will not cover if the results are confirmed by member s self-disclosed admission b. Confirmation by quantitative testing requires either a positive qualitative screening test or an inconsistent result and shall be performed only for the drug

4 Page 4 of 23 class represented by the positive screening or inconsistent result (See D4, Chronic opioid therapy for clinical criteria) B. New patient screening Qualitative IA with confirmation or quantitative testing is considered medically necessary when all of the criteria in Section A are met. New patient screening typically involves the following drugs/drug classes: Alcohol, amphetamines/methamphetamine, barbiturates, cannabinoids, cocaine, methadone, opiates, oxycodone. Note: Request for specialty screening or direct-to-chromatography quantitative analysis, for expanded benzodiazepines and opioid panels to determine the specific drugs in the member s system, may be medically necessary if supported by documentation that substantiates the clinical rationale for the expanded test. (This includes a detailed justification for testing of specific metabolite) C. On-going monitoring typically sufficient with a screening qualitative IA without the need for confirmation or quantitative testing unless documentation and specific rationale supports additional testing. (The need for testing [i.e., that it impacts treatment] must be established at each meeting with previous testing documented in the record) D. Chronic opioid therapy 1. Qualitative drug and alcohol screens will only be covered if documentation includes all of the following: History; current treatment plan; medication prescribed; risk potential for abuse, misuse and diversion accompanied by prescription drug monitoring data or pharmacy profile; use of a validated risk assessment interview (or questionnaire tool) with appropriate risk stratification and monitoring protocols 2. Periodic qualitative monitoring is used to address risk potentials of abuse and diversion of controlled medications and/or abuse of illicit drugs, alcohol or drugs not prescribed as part of the treatment plan and obtained from an undisclosed/unsanctioned source a. Documentation of the validated risk assessment process must establish that the need for testing impacts treatment b. In the absence of specific symptoms of medication aberrant behavior or misuse, qualitative drug testing is only considered reasonable and necessary when titrated to patient risk potential 3. Targeting and select testing of limited drugs of abuse may be medically necessary when there is documentation of suspicious behaviors such as self-escalation of dose, doctorshopping, indications/symptoms of illegal drug use, evidence of diversion or other documented change in affect or behavioral pattern 4. Confirmatory and/or quantitative drug testing may be considered medically necessary when reliable validation (member self-report, prescription drug monitoring data, pharmacy profile, communication from prescribing clinician) is not available and 1 of the following is documented: a. Member reports taking a prescribed opioid, but the drug screen is negative b. Member screens positive for cocaine and is believed to be a chronic cocaine user c. Member screens positive for THC, but documentation supports that the member is discontinuing THC according to the treatment plan d. Screening is positive for stimulant, barbiturate or benzodiazepine class of drug e. Screening is negative, but results are inconsistent with medical history and there is documentation to support the need for confirmatory testing

5 Page 5 of 23 (This does not apply to testing for cocaine, THC or amphetamines except if the member is receiving a prescription for amphetamine for attention deficit disorder [ADD]. The reason for the exception must be documented) Note: Quantitative testing may also be indicated if criteria for testing is met and there is documentation that a qualitative test is not available (e.g., in the case of selected synthetic or semi-synthetic opioids) Qualitative testing frequency for chronic opioid patients For targeted testing, frequency is based upon documentation of suspicious behaviors such as selfescalation of dose, doctor-shopping, indications/symptoms of illegal drug use, evidence of diversion or other documented change in affect or behavioral pattern. Limitations/Exclusions A. Blanket Orders (i.e., routine standing orders for all patients in a physician s practice) are not considered reasonable and necessary are therefore not covered. B. Coverage for point of care testing (POCT) is limited to dipstick screening. C. Confirmatory testing requirements pertaining to lab performing test: 1. Test must be lab-based using the plan s participating lab Quest Diagnostics 2. Use of a nonparticipating lab will be pended for review D. Reflex definitive UDT is not reasonable and necessary when presumptive testing is performed at point of care because the clinician may have sufficient information to manage the member. If the clinician is not satisfied, he/she must determine the clinical appropriateness of and order specific subsequent definitive testing (e.g., the member admits to using a particular drug, or the IA cut-off is set at such a point that is sufficiently low that the physician is satisfied with the presumptive test result). E. It is not reasonable and necessary for a physician to perform presumptive POCT and order presumptive IA testing from a reference laboratory (i.e., EmblemHealth will only pay for one presumptive test result per member per date of service regardless of the number of billing providers). F. It is not reasonable and necessary for a physician to perform presumptive IA testing and order presumptive IA testing from a reference laboratory with or without reflex testing (i.e., EmblemHealth will only pay for one presumptive test result per member per date of service regardless of the number of billing providers). G. It is not reasonable and necessary for a reference laboratory to perform and bill IA presumptive UDT prior to definitive testing without a specific physician s order for the presumptive testing. H. IA testing, regardless of whether it is qualitative or semi-quantitative (numerical), may not be used to confirm or definitively identify a presumptive test result obtained by cups, dipsticks, cards, cassettes or other IA testing methods. Definitive UDT provides specific identification and/or quantification typically by GC-MS or LC-MS/MS. I. Drug testing of two different specimen types from the same member on the same date of service for the same drugs/metabolites/analytes is not covered. J. Drug tests ordered by, or on behalf of, third parties (e.g., courts, employers, schools, etc.) or to protect a physician from drug diversion charges, are not covered. K. Specimen validity testing, including, but not limited to, ph, specific gravity, oxidants and/or creatinine is not covered. L. High complexity testing is not covered in the office-based setting.

6 Page 6 of 23 M. Testing of saliva, blood, hair and nails is not covered, as the medical necessity of such testing has not been established due to insufficient evidence of therapeutic value. N. EmblemHealth does not reimburse for services pertaining to the evaluation of urine dilution (i.e, analysis of creatinine levels). O. Testing must coincide with a paid office visit. Place-of-Service Settings POS 11 POS 33 POS 49 POS 50 POS 51 POS 53 POS 55 POS 56 POS 57 Excluded Office settings Custodial care facility Independent Clinic FQHC Partial Psych Hospital Community Mental Health Residential Substance Abuse Treatment Psych Rehab treatment Non-residential substance abuse center All emergency and inpatient care locations Applicable Procedure Codes A. Presumptive/Qualitative Drug/Alcohol Testing Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); read by instrument assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service Applicable Procedure Codes B. Definitive/Quantitative Urine/Drug Testing G0480 G0481 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrixmatched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays

7 Page 7 of 23 (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrixmatched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed G0482 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrixmatched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; drug class(es), including metabolite(s) if performed G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrixmatched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed G0659 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes Alcohols Alcohol biomarkers; 1 or Alcohol biomarkers; 3 or more Alkaloids, not otherwise specified Amphetamines; 1 or Amphetamines; 3 or Amphetamines; 5 or more Anabolic steroids; 1 or Anabolic steroids; 3 or more Analgesics, non-opioid; 1 or Analgesics, non-opioid; Analgesics, non-opioid; 6 or more Antidepressants, serotonergic class; 1 or Antidepressants, serotonergic class; Antidepressants, serotonergic class; 6 or more Antidepressants, tricyclic and other cyclicals; 1 or Antidepressants, tricyclic and other cyclicals; Antidepressants, tricyclic and other cyclicals; 6 or more Antidepressants, not otherwise specified Antiepileptics, not otherwise specified; 1-3

8 Page 8 of Antiepileptics, not otherwise specified; Antiepileptics, not otherwise specified; 7 or more Antipsychotics, not otherwise specified; Antipsychotics, not otherwise specified; Antipsychotics, not otherwise specified; 7 or more Barbiturates Benzodiazepines; Benzodiazepines; 13 or more Buprenorphine Cannabinoids, natural Cannabinoids, synthetic; Cannabinoids, synthetic; Cannabinoids, synthetic; 7 or more Cocaine Fentanyl Gabapentin, non-blood Heroin metabolite Ketamine and norketamine Methadone Methylenedioxyamphetamines (MDA, MDEA, MDMA) Methylphenidate Opiates, 1 or more Opioids and opiate analogs; 1 or Opioids and opiate analogs; 3 or Opioids and opiate analogs; 5 or more Oxycodone Pregabalin Propoxyphene Sedative hypnotics (non-benzodiazepines) Skeletal muscle relaxants; 1 or Skeletal muscle relaxants; 3 or more Stimulants, synthetic Tapentadol Tramadol Stereoisomer (enantiomer) analysis, single drug class Phencyclidine (PCP) Applicable Diagnosis Codes E87.2 Acidosis F10.11 Alcohol abuse, in remission (Eff.10/01/2017) F10.20 Alcohol dependence, uncomplicated F Alcohol dependence with intoxication, uncomplicated F Alcohol dependence with intoxication delirium F Alcohol dependence with intoxication, unspecified

9 Page 9 of 23 F Alcohol dependence with withdrawal, uncomplicated F Alcohol dependence with withdrawal delirium F Alcohol dependence with withdrawal with perceptual disturbance F Alcohol dependence with withdrawal, unspecified F Alcohol dependence with alcohol-induced psychotic disorder with delusions F Alcohol dependence with alcohol-induced psychotic disorder with hallucinations F Alcohol dependence with alcohol-induced psychotic disorder, unspecified F Alcohol dependence with alcohol-induced anxiety disorder F Alcohol dependence with alcohol-induced sexual dysfunction F Alcohol dependence with alcohol-induced sleep disorder F Alcohol dependence with other alcohol-induced disorder F10.29 Alcohol dependence with unspecified alcohol-induced disorder F11.11 Opioid abuse, in remission (Eff.10/01/2017) F11.20 Opioid dependence, uncomplicated F Opioid dependence with intoxication, uncomplicated F Opioid dependence with intoxication delirium F Opioid dependence with intoxication with perceptual disturbance F Opioid dependence with intoxication, unspecified F11.23 Opioid dependence with withdrawal F11.24 Opioid dependence with opioid-induced mood disorder F Opioid dependence with opioid-induced psychotic disorder with delusions F Opioid dependence with opioid-induced psychotic disorder with hallucinations F Opioid dependence with opioid-induced psychotic disorder, unspecified F Opioid dependence with opioid-induced sexual dysfunction F Opioid dependence with opioid-induced sleep disorder F Opioid dependence with other opioid-induced disorder F11.29 Opioid dependence with unspecified opioid-induced disorder F12.11 Cannabis abuse, in remission (Eff.10/01/2017) F12.20 Cannabis dependence, uncomplicated F Cannabis dependence with intoxication, uncomplicated F Cannabis dependence with intoxication delirium F Cannabis dependence with intoxication with perceptual disturbance F Cannabis dependence with intoxication, unspecified F Cannabis dependence with psychotic disorder with delusions F Cannabis dependence with psychotic disorder with hallucinations F Cannabis dependence with psychotic disorder, unspecified F Cannabis dependence with cannabis-induced anxiety disorder F Cannabis dependence with other cannabis-induced disorder F12.29 Cannabis dependence with unspecified cannabis-induced disorder F13.11 Sedative, hypnotic or anxiolytic abuse, in remission (Eff.10/01/2017) F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated F Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated F Sedative, hypnotic or anxiolytic dependence with intoxication delirium F Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified F Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated

10 Page 10 of 23 F Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance F Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified F Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder F Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder F13.29 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder F14.11 Cocaine abuse, in remission (Eff.10/01/2017) F14.20 Cocaine dependence, uncomplicated F Cocaine dependence with intoxication, uncomplicated F Cocaine dependence with intoxication delirium F Cocaine dependence with intoxication with perceptual disturbance F Cocaine dependence with intoxication, unspecified F14.23 Cocaine dependence with withdrawal F Cocaine dependence with cocaine-induced psychotic disorder with delusions F Cocaine dependence with cocaine-induced psychotic disorder with hallucinations F Cocaine dependence with cocaine-induced psychotic disorder, unspecified F Cocaine dependence with cocaine-induced anxiety disorder F Cocaine dependence with cocaine-induced sexual dysfunction F Cocaine dependence with cocaine-induced sleep disorder F Cocaine dependence with other cocaine-induced disorder F14.29 Cocaine dependence with unspecified cocaine-induced disorder F15.11 Other stimulant abuse, in remission (Eff.10/01/2017) F15.20 Other stimulant dependence, uncomplicated F Other stimulant dependence with intoxication, uncomplicated F Other stimulant dependence with intoxication delirium F Other stimulant dependence with intoxication with perceptual disturbance F Other stimulant dependence with intoxication, unspecified F15.23 Other stimulant dependence with withdrawal F15.24 Other stimulant dependence with stimulant-induced mood disorder F Other stimulant dependence with stimulant-induced psychotic disorder with delusions F Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations F Other stimulant dependence with stimulant-induced psychotic disorder, unspecified F Other stimulant dependence with stimulant-induced anxiety disorder

11 Page 11 of 23 F Other stimulant dependence with stimulant-induced anxiety disorder F Other stimulant dependence with stimulant-induced sleep disorder F Other stimulant dependence with other stimulant-induced disorder F15.29 Other stimulant dependence with unspecified stimulant-induced disorder F16.11 Hallucinogen abuse, in remission (Eff.10/01/2017) F16.20 Hallucinogen dependence, uncomplicated F Hallucinogen dependence with intoxication, uncomplicated F Hallucinogen dependence with intoxication with delirium F Hallucinogen dependence with intoxication, unspecified F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder F Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions F Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations F Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified F Hallucinogen dependence with hallucinogen-induced anxiety disorder F Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks) F Hallucinogen dependence with other hallucinogen-induced disorder F16.29 Hallucinogen dependence with unspecified hallucinogen-induced disorder F18.10 Inhalant abuse, uncomplicated F18.11 Inhalant abuse, in remission (Eff.10/01/2017) F Inhalant abuse with intoxication, uncomplicated F18.20 Inhalant dependence, uncomplicated F Inhalant dependence with intoxication, uncomplicated F Inhalant dependence with intoxication delirium F Inhalant dependence with intoxication, unspecified F18.24 Inhalant dependence with inhalant-induced mood disorder F Inhalant dependence with inhalant-induced psychotic disorder with delusions F Inhalant dependence with inhalant-induced psychotic disorder with hallucinations F Inhalant dependence with inhalant-induced psychotic disorder, unspecified F18.27 Inhalant dependence with inhalant-induced dementia F Inhalant dependence with inhalant-induced anxiety disorder F Inhalant dependence with other inhalant-induced disorder F18.29 Inhalant dependence with unspecified inhalant-induced disorder F18.90 Inhalant use, unspecified, uncomplicated F19.11 Other psychoactive substance abuse, in remission (Eff.10/01/2017) F19.20 Other psychoactive substance dependence, uncomplicated F Other psychoactive substance dependence with intoxication, uncomplicated F Other psychoactive substance dependence with intoxication delirium F Other psychoactive substance dependence with intoxication with perceptual disturbance F Other psychoactive substance dependence with intoxication, unspecified F Other psychoactive substance dependence with withdrawal, uncomplicated F Other psychoactive substance dependence with withdrawal delirium F Other psychoactive substance dependence with withdrawal with perceptual disturbance F Other psychoactive substance dependence with withdrawal, unspecified F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder F Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with

12 Page 12 of 23 delusions F Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations F Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia F Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder F Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction F Other psychoactive substance dependence with psychoactive substance-induced sleep disorder F Other psychoactive substance dependence with other psychoactive substance-induced disorder F19.29 Other psychoactive substance dependence with unspecified psychoactive substance-induced disorder F20.0 Paranoid schizophrenia F20.1 Disorganized schizophrenia F20.2 Catatonic schizophrenia F20.89 Other schizophrenia F55.0 Abuse of antacids F55.1 Abuse of herbal or folk remedies F55.2 Abuse of laxatives F55.3 Abuse of steroids or hormones F55.4 Abuse of vitamins F55.8 Abuse of other non-psychoactive substances G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus G Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus G Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus G Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus G Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus G Epilepsy, unspecified, not intractable, with status epilepticus G Epilepsy, unspecified, not intractable, without status epilepticus G Epilepsy, unspecified, intractable, with status epilepticus G Epilepsy, unspecified, intractable, without status epilepticus G89.29 Other chronic pain G89.4 Chronic pain syndrome I44.0 Atrioventricular block, first degree I44.1 Atrioventricular block, second degree I44.30 Unspecified atrioventricular block I45.81 Long QT syndrome I47.0 Re-entry ventricular arrhythmia I47.1 Supraventricular tachycardia I47.2 Ventricular tachycardia I49.2 Junctional premature depolarization M25.50 Pain in unspecified joint

13 Page 13 of 23 M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region M47.22 Other spondylosis with radiculopathy, cervical region M47.23 Other spondylosis with radiculopathy, cervicothoracic region M47.26 Other spondylosis with radiculopathy, lumbar region M47.27 Other spondylosis with radiculopathy, lumbar region M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region M Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region M Spondylosis without myelopathy or radiculopathy, cervical region M Spondylosis without myelopathy or radiculopathy, cervicothoracic region M Spondylosis without myelopathy or radiculopathy, lumbar region M Spondylosis without myelopathy or radiculopathy, lumbosacral region M Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region M Other spondylosis, occipito-atlanto-axial region M Other spondylosis, cervical region M Other spondylosis, cervicothoracic region M Other spondylosis, lumbar region M Other spondylosis, lumbosacral region M Other spondylosis, sacral and sacrococcygeal region M51.14 Intervertebral disc disorders with radiculopathy, thoracic region M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region M51.16 Intervertebral disc disorders with radiculopathy, lumbar region M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region M51.36 Other intervertebral disc degeneration, lumbar region M51.37 Other intervertebral disc degeneration, lumbosacral region M54.14 Radiculopathy, thoracic region M54.15 Radiculopathy, thoracolumbar region M54.16 Radiculopathy, lumbar region M54.17 Radiculopathy, lumbosacral region M54.18 Radiculopathy, sacral and sacrococcygeal region M54.2 Cervicalgia M54.5 Low back pain M Other myositis, right shoulder M Other myositis, left shoulder M Other myositis, right upper arm M Other myositis, left upper arm M Other myositis, right forearm M Other myositis, left forearm M Other myositis, right hand M Other myositis, left hand M Other myositis, right thigh M Other myositis, left thigh M Other myositis, right lower leg M Other myositis, left lower leg M Other myositis, right ankle and foot M Other myositis, left ankle and foot

14 Page 14 of 23 M60.88 Other myositis, other site M60.89 Other myositis, multiple sites M60.9 Myositis, unspecified M79.1 Myalgia M79.2 Neuralgia and neuritis, unspecified M79.7 Fibromyalgia R40.0 Somnolence R40.1 Stupor R40.20 Unspecified coma R Coma scale, eyes open, never, unspecified time R Coma scale, eyes open, never, at arrival to emergency department R Coma scale, eyes open, never, at hospital admission R Coma scale, eyes open, never, 24 hours or more after hospital admission R Coma scale, eyes open, to pain, unspecified time R Coma scale, eyes open, to pain, unspecified time R Coma scale, eyes open, to pain, in the field [EMT or ambulance] R Coma scale, eyes open, to pain, at arrival to emergency department R Coma scale, eyes open, to pain, at hospital admission R Coma scale, eyes open, to pain, 24 hours or more after hospital admission R Coma scale, best verbal response, none, unspecified time R Coma scale, best verbal response, none, in the field [EMT or ambulance] R Coma scale, best verbal response, none, at arrival to emergency department R Coma scale, best verbal response, none, at hospital admission R Coma scale, best verbal response, none, 24 hours or more after hospital admission R Coma scale, best verbal response, incomprehensible words, unspecified time R Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance] R Coma scale, best verbal response, incomprehensible words, at arrival to emergency department R Coma scale, best verbal response, incomprehensible words, at hospital admission R Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission R Coma scale, best motor response, none, unspecified time R Coma scale, best motor response, none, in the field [EMT or ambulance] R Coma scale, best motor response, none, at arrival to emergency department R Coma scale, best motor response, none, at hospital admission R Coma scale, best motor response, none, 24 hours or more after hospital admission R Coma scale, best motor response, extension, unspecified time R Coma scale, best motor response, extension, in the field [EMT or ambulance] R Coma scale, best motor response, extension, at arrival to emergency department R Coma scale, best motor response, extension, at hospital admission R Coma scale, best motor response, extension, 24 hours or more after hospital admission R Coma scale, best motor response, flexion withdrawal, unspecified time R Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance] R Coma scale, best motor response, flexion withdrawal, at arrival to emergency department R Coma scale, best motor response, flexion withdrawal, at hospital admission R Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission R41.82 Altered mental status, unspecified

15 Page 15 of 23 R44.0 Auditory hallucinations R44.2 Other hallucinations R44.3 Hallucinations, unspecified R56.9 Unspecified convulsions T14.91XA Suicide attempt, initial encounter (Eff. 10/01/2017) T14.91XD Suicide attempt, subsequent encounter (Eff. 10/01/2017) T14.91XS Suicide attempt, sequela (Eff. 10/01/2017) T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter T39.012A Poisoning by aspirin, intentional self-harm, initial encounter T39.013A Poisoning by aspirin, assault, initial encounter T39.014A Poisoning by aspirin, undetermined, initial encounter T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter T39.092A Poisoning by salicylates, intentional self-harm, initial encounter T39.093A Poisoning by salicylates, assault, initial encounter T39.094A Poisoning by salicylates, undetermined, initial encounter T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental (unintentional), initial encounter T39.1X2A Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter T39.1X3A Poisoning by 4-Aminophenol derivatives, assault, initial encounter T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, initial encounter T39.2X1A Poisoning by pyrazolone derivatives, accidental (unintentional), initial encounter T39.2X2A Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter T39.2X3A Poisoning by pyrazolone derivatives, assault, initial encounter T39.2X4A Poisoning by pyrazolone derivatives, undetermined, initial encounter T39.311A Poisoning by propionic acid derivatives, accidental (unintentional), initial encounter T39.312A Poisoning by propionic acid derivatives, intentional self-harm, initial encounter T A Poisoning by propionic acid derivatives, assault, initial encounter T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter T39.391A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], accidental (unintentional), initial encounter T39.392A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm, initial encounter T39.393A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], assault, initial encounter T39.394A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], undetermined, initial encounter T40.0X1A Poisoning by opium, accidental (unintentional), initial encounter T40.0X2A Poisoning by opium, intentional self-harm, initial encounter T40.0X3A Poisoning by opium, assault, initial encounter T40.0X4A Poisoning by opium, undetermined, initial encounter T40.1X1A Poisoning by heroin, accidental (unintentional), initial encounter T40.1X2A Poisoning by heroin, intentional self-harm, initial encounter T40.1X3A Poisoning by heroin, assault, initial encounter T40.1X4A Poisoning by heroin, undetermined, initial encounter T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter T40.2X2A Poisoning by other opioids, intentional self-harm, initial encounter T40.2X3A Poisoning by other opioids, assault, initial encounter T40.2X4A Poisoning by other opioids, undetermined, initial encounter T40.3X1A Poisoning by methadone, accidental (unintentional), initial encounter

16 Page 16 of 23 T40.3X2A T40.3X3A T40.3X4A T40.4X1A T40.4X2A T40.4X3A T40.4X4A T40.5X1A T40.5X2A T40.5X3A T40.5X4A T40.601A T40.602A T40.603A T40.604A T40.691A T40.692A T40.693A T40.694A T40.7X1A T40.7X2A T40.7X3A T40.7X4A T40.8X1A T40.8X2A T40.8X3A T40.8X4A T40.901A T40.902A T40.903A T40.904A T40.991A T40.992A T40.993A T40.994A T42.0X1A T42.0X2A T42.0X3A T42.0X4A T42.3X1A T42.3X2A T42.3X3A T42.3X4A T42.4X1A T42.4X2A Poisoning by methadone, intentional self-harm, initial encounter Poisoning by methadone, assault, initial encounter Poisoning by methadone, undetermined, initial encounter Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter Poisoning by other synthetic narcotics, intentional self-harm, initial encounter Poisoning by other synthetic narcotics, assault, initial encounter Poisoning by other synthetic narcotics, undetermined, initial encounter Poisoning by cocaine, accidental (unintentional), initial encounter Poisoning by cocaine, intentional self-harm, initial encounter Poisoning by cocaine, assault, initial encounter Poisoning by cocaine, undetermined, initial encounter Poisoning by unspecified narcotics, accidental (unintentional), initial encounter Poisoning by unspecified narcotics, intentional self-harm, initial encounter Poisoning by unspecified narcotics, assault, initial encounter Poisoning by unspecified narcotics, undetermined, initial encounter Poisoning by other narcotics, accidental (unintentional), initial encounter Poisoning by other narcotics, intentional self-harm, initial encounter Poisoning by other narcotics, assault, initial encounter Poisoning by other narcotics, undetermined, initial encounter Poisoning by cannabis (derivatives), accidental (unintentional), initial encounter Poisoning by cannabis (derivatives), intentional self-harm, initial encounter Poisoning by cannabis (derivatives), assault, initial encounter Poisoning by cannabis (derivatives), undetermined, initial encounter Poisoning by lysergide [LSD], accidental (unintentional), initial encounter Poisoning by lysergide [LSD], intentional self-harm, initial encounter Poisoning by lysergide [LSD], assault, initial encounter Poisoning by lysergide [LSD], undetermined, initial encounter Poisoning by unspecified psychodysleptics [hallucinogens], accidental (unintentional), initial encounter Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm, initial encounter Poisoning by unspecified psychodysleptics [hallucinogens], assault, initial encounter Poisoning by unspecified psychodysleptics [hallucinogens], undetermined, initial encounter Poisoning by other psychodysleptics [hallucinogens], accidental (unintentional), initial encounter Poisoning by other psychodysleptics [hallucinogens], intentional self-harm, initial encounter Poisoning by other psychodysleptics [hallucinogens], assault, initial encounter Poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter Poisoning by hydantoin derivatives, accidental (unintentional), initial encounter Poisoning by hydantoin derivatives, intentional self-harm, initial encounter Poisoning by hydantoin derivatives, assault, initial encounter Poisoning by hydantoin derivatives, undetermined, initial encounter Poisoning by barbiturates, accidental (unintentional), initial encounter Poisoning by barbiturates, intentional self-harm, initial encounter Poisoning by barbiturates, assault, initial encounter Poisoning by barbiturates, undetermined, initial encounter Poisoning by benzodiazepines, accidental (unintentional), initial encounter Poisoning by benzodiazepines, intentional self-harm, initial encounter

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