Although the conditions for prescribing medical marijuanadiffer from state to state, there are many similarities. (Photo:Shutterstock)

The industry is in a haze, and it’s from marijuana— legalized medical marijuana. So many questionsand not enough answers when it comes to established claimsguidelines for reimbursement:

• Is cannabis falling into the abyss of the property and casualtyclaims payment systems?
• What do claims professionals do when they encounter a medicalbill for cannabis?
• Why are there are no valid codes for submission for payment inthe Current Procedural Terminology (CPT), Healthcare CommonProcedural Coding System (HCPCS) or National Drug Code (NDC) formedical marijuana?

There actually is an answer to the last question because theFood and Drug Administration (FDA) still classifies medical marijuana as a Schedule I drug. The FDAhas not approved marijuana as a safe and effective drug for anyindication (FDA, 2017). Its classification as a Schedule I drugunder the Controlled Substances Act of 1970 indicates thatmarijuana has a high potential for abuse, does not currently havean accepted medical use and has a lack of accepted safety for useunder medical supervision. Other Schedule I drugs include heroinand hallucinogens like LSD.

Legalization in the U.S.

At the state level, there are currently 29 states plus theDistrict of Columbia that have legalized medical marijuana(ProCon.Org, 2017). They are:

• Alaska*
• Arizona
• Arkansas
• California*
• Colorado*
• Connecticut
• Delaware
• Florida
• Hawaii
• Illinois
• Maine*
• Maryland
• Massachusetts*
• Michigan
• Minnesota
• Montana
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Dakota
• Ohio
• Oregon*
• Pennsylvania
• Rhode Island
• Vermont
• Washington*
• West Virginia
• Washington, D.C.

Of these states, seven have also legalized marijuana forrecreational use in addition to medical marijuana.

Related: Workplace safety and weed at work

Marijuana has found to be an effective treatment for a widevariety of medical conditions. (Photo: Shutterstock)

Legalized marijuana and claims

In states where medical marijuana has been legalized, theyspecify qualifying conditions for which marijuana can beprescribed. Here in the property & casualty (P&C) industry,we are concerned with those conditions related to workers’compensation and auto accidents. Although the conditions forprescribing medical marijuana differ from state to state, there aremany similarities.

Related: Legalizing recreational marijuana linked toincreased car crashes, insurance study finds

Conditions such as pain, spinal cord injury, traumatic braininjuries, muscle spasms, post-traumatic stress syndrome and morecan be seen in accident injury cases. Some states even have “otherchronic or persistent medical conditions” approved forprescription, which can lead to seeing claims where the doctor isprescribing for non-specific diagnoses.

Insurers should be aware that non-specific diagnoses codes canappear on submitted medical bills using the InternationalClassification of Diseases – 10th Revision, Clinical Modification(ICD-10-CM), using the following example codes:

M79.604 – Pain in right lower limb, nototherwise specified.

G89.21 – Chronic pain due to trauma.

M54.5 – Low back pain.

When pain is the only diagnosis on the bill (claim), it isprobably best to request additional codes to isolate the injury.For the ICD-10-CM, G89 codes may be used in conjunction with codesfrom other categories and chapters to provide more detail aboutacute or chronic pain and neoplasmrelated pain, unless otherwiseindicated in other guidelines.

Legalized marijuana and workplace safetyconcerns

A major concern with patients using medical marijuana is theeffect it may have on them while at work and operating equipmentlike motorized vehicles. Driving under the influence (DUI) laws formarijuana are similar to that of using alcohol.

Until recently, it was more difficult for law enforcement totest for marijuana intoxication. However, some states, likeCalifornia, have recently unveiled a newer detection system thatuses a mobile saliva screening device. In addition to testing formarijuana this device will also test for cocaine, amphetamines andprescription narcotics.

According to the NationalInstitute on Drug Abuse, after alcohol, marijuana is the drugmost often found in the blood of drivers involved in crashes. Todetect marijuana in drivers, the tests measure the level ofdelta-9- tetrahydrocannabinol (THC), marijuana’s mind-alteringingredient, in the blood. But the role that marijuana plays incrashes is often unclear (www.drugabuse.gov,2016).

With all the possibilities of a driver or worker either beingprescribed or using recreational marijuana, not only are futureaccidents highly probable, but so are the additional prescriptionsbeing prescribed for injuries they receive. Today, the majority ofcasualty claim payers do not cover medical marijuana prescriptions.However, we are seeing a number of instances where judges haveforced workers’ compensation payers to reimburse claimants. Thesecases are few and have occurred in states like in New Jersey,Maine, Connecticut, Minnesota and New Mexico.

Coding the legalized marijuana claim

If a payer received a claim to cover medical marijuana, how wouldthey recognize the drug without any ability to submit it usingappropriate codes?

Since the FDA has not approved marijuana, there are no codes orstandardized nomenclatures available for communicating theprescribing of legalized marijuana from providers to payers. Whatwe see in claims is documented evidence of medical marijuana beingused by claimants and creative use of the nomenclatures currentlyused for reimbursement.

Some of the codes and situations being billed that includemedical marijuana are:

• CPT code 99070 (American Medical Association) – Supplies andmaterials provided by the physician or other qualified health careprofessional over and above those usually included with the officevisit or other services rendered (list drugs, trays, supplies ormaterials provided).
• When CPT Code 99070 is submitted, the provider must submit inwriting if necessary the listing of drugs, trays, supplies ormaterials provided.
• It is difficult to make the distinction unless thedocumentation is reviewed. It would be difficult to review everysupply code (99070) as these are prevalent among claims.
• Evaluation and management codes – Bundling the cost of themedical marijuana into the cost of the office or visit code is moredifficult to ascertain as these codes are used to legitimatelyreport the encounter.
• Any drugs would need to be identified in the documentation ofthe visit, which is usually where we will encounter a prescriptionmessage from the provider.
• Using the ICD-10-CM codes as a guide and the potential pricingof the encounter may lead to clues in outlining where to look forthese cases.
• Unclassified drug codes (HCPCS) –|
  • Many of the following codes do not make complete sense to useas the descriptions do not match medical marijuana. However, theseare the code sets used when documentation was obtained thatrepresented medical marijuana billing.
  • J3490 – Unclassified drugs
  • J7599 – Immunosuppressive drug, not otherwise classified
  • J7699 – NOC drugs, inhalation solution administered throughDME
  • J7799 – NOC drugs, other than inhalation drugs, administeredthrough DME
  • J8499 – Prescription drug, oral, non-chemotherapeutic, NOS
  • J8999 – Prescription drug oral, chemotherapeutic, NOS
  • J9999 – Not otherwise classified, antineoplastic drugs

One thing is clear: raising this topic has shown that thecurrent state of claims payments for medical marijuana has yet tobe defined. So what is the answer? It’s actually a multi-stepprocess that needs to take place to get to any kind of establishedprotocol.

First, a main step in moving forward with acceptance would beobtaining FDA approval and movement to a Schedule II or III drug.Once acceptance is given at this level, classifications thataccurately identify the drug must be established. And finally, oncemarijuana is classified, the difficult work of protocols andacceptance of this treatment in workers’ compensation and autoclaims begins, and the haze will end.

Related: Cannabis compliance software eases businessinsurance snags

Michele Hibbert-Iacobacci, CCSP, OHCC, ([email protected]) is vice president ofInformation and Support for Mitchell Casualty Solutions.