What the world needs is obviously more LU codes...
Long story short:
1) LU codes for 25 and 50mcg/h patches will be changed starting October 1, 2017
2) Current LU code for fentanyl patches is "201", it will be deactivated
3) Patients will need to be transitioned to LU code "511"
4) While you contact the prescriber for a new LU code, you can still use a transition code of "279" from now until December while you wait for prescriber reply
5) Also, when you submit a claim for 25 or 50mcg/h fentanyl patches, ODB will search through NMS and HNS over the past 180 days to determine if patient received a long-acting opioid or fentanyl patch before it accepts.
Your next steps:
Fax/contact all prescribers for all your 25 and 50mcg/h fentanyl patients for new LU codes
Why did ODB implement these changes?
"Analysis of ODB claims for fentanyl transdermal patches has demonstrated that up to 60% of claims did not meet the LU criterion of requiring prior use of a long-acting opioid. Approximately 16% of ODB recipients on fentanyl patches had no prior opioid use at all."
More details here:
News that has been personally selected by the Editorial team.