Substance Use Disorders in the Primary Care Setting

Substance use disorders (SUDs) are prevalent and far-reaching, but screening and early detection in the primary care setting and a comprehensive treatment plan including behavioral health (BH) specialty services can set patients on the path to wellness. CarePartners of Connecticut appreciates your continued support in screening for SUDs.

NCQA’s Initiation and Engagement of Alcohol and Other Drug Dependence treatment (IET) HEDIS measure assesses adults and adolescents with a new episode of alcohol or other drug (AOD) dependence who initiated treatment within two weeks of diagnosis, as well as those who initiated treatment and had two or more additional related services or treatments within 34 days of the initiation visit.

Behavioral Health
CarePartners of Connecticut makes resources available to support providers and their patients in coordinating an effective treatment plan:

  • For providers working in offices with an integrated care model, referral to the BH provider for an evaluation could be an important first step. Your patient may feel more comfortable having an initial evaluation with a provider within your office. The dx on the claim must be the same as the dx the PCP submitted to be compliant for this HEDIS measure.
  • If a patient is not interested in being referred to a BH provider, ongoing follow up visits by the PCP office, even by telehealth, will continue to satisfy compliance for the HEDIS measure. Telehealth and virtual visits count as compliant for the HEDIS measure as long as SUD diagnosis is on the claim.

Additional Resources

  • Members and providers can use CarePartners of Connecticut’s online Doctor Search to find a provider.
  • CarePartners of Connecticut’s Care Management programs support patients, including assisting with engaging in and adhering to a BH plan of care or a substance use recovery plan.
  • Providers can direct members to call Member Services at 888.341.1507 (TTY: 711) Claims Coding Tips for Alcohol and SUDs
  • Providers who diagnosis patients with SUDs should continue to document the diagnosis code on follow-up claims to denote that follow-up has occurred.
  • For patients who are using long-term medication for pain, use code Z79.891 (long-term current use of opiate analgesic). This code does not denote an SUD.
  • Use a “1” at the end of a substance use diagnosis code to document that the condition is in remission, e.g., F10.11, (Alcohol Use Disorder, Mild, In early or sustained remission).