Frequently Asked Questions
Prescribing of Controlled Substances
#1. How do I obtain medical records for a patient that I am only seeing for an emergency?
AB474 requires a good faith effort to obtain medical records before prescribing a controlled substance, and a mandatory check of the prescription monitoring program (PMP). This is an excellent question and the NDA government affairs team is seeking further clarification from the state on this point through the FAQ process.
#2. Will the NDA provide a template to use?
NDA will provide, on our website member page (nvda.org/advocacy/member)
links to:
- A sample informed written consent form provided by NDA officer Dr. Mark Funke, working with the NDA Executive Board and Board of Dental Examiners counsel;
- A link to the checklist provided by the State for the required elements of AB474 (initial patient risk assessment, quantity limits, informed written consent, and prescription medication agreements for prescriptions longer than 30 days), as well as a link to additional sample informed written consents and a sample prescription label.
These forms can be edited to your specific need.
Remember that these forms are tools, but you are responsible for knowing the mandatory elements of the law, as summarized in the White Paper we have sent to members, and available on the website. Links to these documents will be posted on the NDA member page at nvda.org/advocacy/member.
#3. What are Opioids?
Here is a list of the most common types of scheduled drugs prescribed in dental offices (Opioids are a class of drugs or painkillers for example: Fentanyl, Percocet®, hydrocodone (Vicodin), OxyContin®, Demerol®, oxycodone (OxyContin®), codeine, morphine).
For further guidance, here are the definitions used by the CDC:
Opioid – Natural or synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. This is a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others. Opioid pain medications 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.
Opioid analgesics – Commonly referred to as prescription opioids, medications that have been used to treat moderate to severe pain in some patients. Categories of opioids for mortality data include:
- Natural opioid analgesics, including morphine and codeine;
- Semi-synthetic opioid analgesics, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone;
- Methadone, a synthetic opioid;
- Synthetic opioid analgesics other than methadone, including drugs such as tramadol and fentanyl.
#4. If I am prescribing antibiotics, will I still need to have a code? No, these changes do not apply to prescribing antibiotics because they are not controlled substances. The new law applies in part to controlled substances (Schedule II-IV) prescribed for pain, and with respect to the requirements for prescription labeling, to controlled substances Schedule II-IV. The Board of Pharmacy intends to clarify this distinction via regulation, as other legislation during the 2017 session may also require ICD-10 codes on Schedule V drugs.
#5. Are these codes for procedures or conditions? The ICD-10 codes are for conditions.
#6. Who provided the codes? The sample ICD-10 code list was developed for NDA members by NDA officer Dr. Mark Funke. You may also find it helpful to review ADA’s resource list on this topic; the ADA reports here that most of the codes for common dental procedures are located in Chapter 11 of the ICD-10: http://www.ada.org/en/member-center/member-benefits/practice-resources/dental-informatics/standard-terminologies-and-codes/faq-icd-10-cm
#7. How do include the codes if I am using Dentrix? It is the responsibility of the software providers to update their systems to reflect the changes in Nevada law under Assembly Bill 474 of the 2017 Legislative Session and the implementing regulations. If you need a copy of the law to send to your vendor, you can find a link to the bill here. If you would like copy of the white paper/overview of the law to send to your vendor, you can find these on the NDA member page at nvda.org/advocacy/member. In the meantime, you should be able to handwrite the codes on the prescription.
* If you are having problems with your vendor, please report them to NDA.
