Representing Alcohol Use

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Standard	HCPCS Level II	Final	Production	No	Free	N/A
Standard for observations	LOINC®	Final	Production	Yes	Free	N/A
Standard for observation values	SNOMED CT® U.S. Edition	Final	Production	No	Free	N/A
Standard	CPT®	Final	Production	No	$	N/A
Standard for observation values	Unified Code for Units of Measure	Final	Production	Yes	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
The optional 2015 Edition Cures Act Social, psychological, and behavioral data criterion (170.315(a)(15)) specifies LOINC codes for exchanging alcohol use observations. This criterion was not changed in HTI-1. The Alcohol Use Disorder Identification Test - Consumption [AUDIT-C] contains a subset of the World Health Organization’s 10-question AUDIT alcohol screening. Both are used to identify patients who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence). Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Units of measure for quantitative result values must be represented using UCUM, see Representing Units of Measure. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	AUDIT-C Panel: LOINC 72109-2 AUDIT Panel: LOINC code 72110-0 HTI-1 Requirements

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

The optional 2015 Edition Cures Act Social, psychological, and behavioral data criterion (170.315(a)(15)) specifies LOINC codes for exchanging alcohol use observations. This criterion was not changed in HTI-1.
The Alcohol Use Disorder Identification Test - Consumption [AUDIT-C] contains a subset of the World Health Organization’s 10-question AUDIT alcohol screening. Both are used to identify patients who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence).
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders.
Units of measure for quantitative result values must be represented using UCUM, see Representing Units of Measure.
For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

AUDIT-C Panel: LOINC 72109-2
AUDIT Panel: LOINC code 72110-0
HTI-1 Requirements

Comment

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

NCPDP supports the use of SNOMED CT.

Submitted by pwilson@ncpdp.org on 2020-11-07

NCPDP Comment

Substance use fields are available in NCPDP SCRIPT Standard Version 2017071 to allow alcohol use information to be transmitted via SNOMED codes
Add the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 1

Federally Required – Yes

Cost – $

Test Tool Availability – Yes

Include Test Tool Link: https://tools.ncpdp.org/erx/#/home

Submitted by mattreid on 2020-03-26

The AMA requests that the…

The AMA requests that the Current Procedural Terminology (CPT) code set be added to the standards listed in Section I: Representing Alcohol Use. CPT codes 99408 and 99409 identify patient screening and intervention for alcohol abuse. CPT codes 8032-80322 identify testing for alcohol. CPT code 82075 identifies an alcohol breath test.

In addition, CPT Category II codes identify a patient screened for unhealthy alcohol use (3016F), patient counseled about risks of alcohol use (4158F), and patient counseled for pharmacologic treatment for alcohol dependence (4320F).

CPT is a comprehensive and regularly curated uniform language that accurately describes medical, surgical, and diagnostic services and provides for reliable communication among users. It has an extremely robust and mature development process with open and transparent meetings and clinical input from national medical specialties and relevant stakeholders. It is the most widely adopted outpatient procedure code set. Use of the CPT code set is federally required under HIPAA.

Submitted by pwilson@ncpdp.org on 2019-09-23

NCPDP Comment

The SubstanceUse fields will be available in NCPDP SCRIPT Standard Version 2017071 to allow alcohol use information to be transmitted via SNOMED codes.

Submitted by pwilson@ncpdp.org on 2018-10-01

NCPDP Comment

Alcohol Use reporting via SNOMED codes is available in the NCPDP SCRIPT Standard Version 2017071.

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071

Standards Process Maturity – Final

Implementation Maturity- Pilot

Adoption Level – 1

Federally Required – No

Cost – $

Test Tool Availability – Yes.

Submitted by cmcdonald on 2018-10-01

Since this LOINC code and…

Since this LOINC code and answer set has been developed (30 behavior and functional status variables suggested by the IOM report and adopted for requirement in the last MU NPRM), the adoption level could now be very high.

Submitted by pwilson@ncpdp.org on 2017-11-20

NCPDP - Comments

SNOMED – Not currently used in NCPDP MMA mandated standards. Future versions of the NCPDP SCRIPT standard support SNOMED.

Submitted by andersol on 2017-10-06

Consider adding additional screening tools

The Joint Commission currently has 3 chart-abstracted quality measures screening for alcohol use and treatment (SUB-1, SUB-2/2a, and SUB-3/3a) that are used by The Joint Commission and CMS in quality reporting programs. We agree with inclusion of the Audit-C, as that is a validated screening tool for unhealthy alcohol use. However, we also think that the AUDIT tool should be included as well. This tool is also a validated survey instrument, and seems to be the most commonly used one for our chart-abstracted measures. LOINC currently has 72110-0 Alcohol Use Disorder Identification Test [AUDIT] and 75624-7 Total Score [AUDIT]. In order for use, the rest of the questions from the survey instrument would need to be added in LOINC as well as the LOINC answer lists.

Submitted by Albert Taylor on 2017-12-12

AUDIT 10-question panel

Thank you for your comment. We have added the full AUDIT panel code and the total score code. This does not imply any requirement for an EHR or other health IT system to capture the AUDIT test questions or total score, but we recognize that this test may currently be in use.