NYSDA recently learned that CVS Pharmacy has instituted a new nationwide policy requiring providers to include a diagnostic code or diagnosis when prescribing a controlled substance for a patient. This is a result of their 2023 Global Opioid Settlement and to help address prescription opioid abuse.

NYSDA confirmed this information with both the American Dental Association and the NYS Bureau of Narcotic Enforcement (BNE) and was told that it is only for controlled substances. Although it is not legally required for dentists or physicians to provide diagnosis codes (ICD-10-CM) when prescribing controlled substances (with the exception of 90-day supply Rxs written for specific indications), pharmacists are allowed to deny an Rx and ask for more information from the provider.

According to CVS and BNE, when prescribing a controlled substance, dentists should include either the diagnosis code or the diagnosis in the “Comments” field of their e-prescribing software. Wording such as “for use after dental surgery” would suffice.

Resources for Obtaining Diagnosis Codes

• The CDT manual includes “Section 3: ICD-10-CM Diagnoses for Dental Diseases and Conditions,” which serves as a sampling of the complete ICD-10-CM code set and contains entries identified as pertinent to most encounters with and services provided to a dentist’s patient and guidance on their structure for reporting.
• The CDT Coding Companion is a reference and educational manual that includes general information on medical benefit claim resources regarding filing. “Appendix 2: CDT Code to ICD (Diagnosis) Code Crosswalk” (located under the “Documents” heading) is posted online at Coding Education | American Dental Association (ada.org), available to download for free.
• The CDC website, where a diagnosis can be entered into the search field to obtain an ICD-10-CM code:  https://icd10cmtool.cdc.gov/

Providers with questions may contact Jacquie Donnelly at NYSDA (jdonnelly@nysdental.org) or the appropriate CVS Pharmacy directly.