like motorized vehicles. Driving under the influence (DUI) laws
for marijuana are similar to that of using alcohol. Until recently,
it was more difficult for law enforcement to test for marijuana intoxication. However, some states, like California, have recently unveiled a newer detection system that uses a mobile saliva screening
device. In addition to testing for marijuana this device will also
test for cocaine, amphetamines and prescription narcotics.
According to the National Institute on Drug Abuse, after alcohol, marijuana is the drug most often found in the blood of drivers
involved in crashes. To detect marijuana in drivers, the tests measure the level of delta-9- tetrahydrocannabinol (THC), marijuana’s
mind-altering ingredient, in the blood. But the role that marijuana
plays in crashes is often unclear ( www.drugabuse.gov, 2016).
With all the possibilities of a driver or worker either being
prescribed or using recreational marijuana, not only are future
accidents highly probable, but so are the additional prescriptions
being prescribed for injuries they receive. Today, the majority
of casualty claim payers do not cover medical marijuana prescriptions. However, we are seeing a number of instances where
judges have forced workers’ compensation payers to reimburse
claimants. These cases 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
would they recognize the drug without any ability to submit it
using appropriate codes?
Since the FDA has not approved marijuana, there are no codes
or standardized nomenclatures available for communicating
the prescribing of legalized marijuana from providers to payers.
What we see in claims is documented evidence of medical marijuana being used by claimants and creative use of the nomenclatures currently used for reimbursement.
Some of the codes and situations being billed that include
medical marijuana are:
• CPT code 99070 (American Medical Association) – Supplies
and materials provided by the physician or other qualified
health care professional over and above those usually in-
cluded with the office visit or other services rendered (list
drugs, trays, supplies or materials provided).
• When CPT Code 99070 is submitted, the provider must
submit in writing if necessary the listing of drugs, trays,
supplies or materials provided.
• It is difficult to make the distinction unless the documentation is reviewed. It would be difficult to review every
supply code (99070) as these are prevalent among claims.
• Evaluation and management codes – Bundling the cost of
the medical marijuana into the cost of the office or visit
code is more difficult to ascertain as these codes are used
to legitimately report the encounter.
• Any drugs would need to be identified in the documentation of the visit, which is usually where we will encounter a prescription message from the provider.
• Using the ICD-10-CM codes as a guide and the potential
pricing of the encounter may lead to clues in outlining
where to look for these cases.
• Unclassified drug codes (HCPCS) –
• Many of the following codes do not make complete
sense to use as the descriptions do not match medical
marijuana. However, these are the code sets used when
documentation was obtained that represented medical
• J3490 – Unclassified drugs
• J7599 – Immunosuppressive drug, not otherwise classified
• J7699 – NOC drugs, inhalation solution administered
• J7799 – NOC drugs, other than inhalation drugs, administered through DME
• J8499 – Prescription drug, oral, non-chemotherapeutic,
• J8999 – Prescription drug oral, chemotherapeutic, NOS
• J9999 – Not otherwise classified, antineoplastic drugs
One thing is clear: raising this topic has shown that the cur-
rent state of claims payments for medical marijuana has yet to be
defined. So what is the answer? It’s actually a multi-step process
that needs to take place to get to any kind of established protocol.
First, a main step in moving forward with acceptance would
be obtaining FDA approval and movement to a Schedule II or
III drug. Once acceptance is given at this level, classifications
that accurately identify the drug must be established. And finally,
once marijuana is classified, the difficult work of protocols and
acceptance of this treatment in workers’ compensation and auto
claims begins, and the haze will end.
Michele Hibbert-Iacobacci, CCSP, OHCC, (Michele.Hibbert@
mitchell.com) is vice president of Information and Support for
Mitchell Casualty Solutions.
DRIVING UNDER THE INFLUENCE (DUI)
LAWS FOR MARIJUANA ARE SIMILAR
TO THAT OF USING ALCOHOL.