The Technical Requirement That Nearly Killed Haslam’s Opioid Package

The finer points of a bill to heavily restrict opioid prescribing came down to the final hours of the legislative session, with a hang-up over medical coding nearly killing Gov. Bill Haslam’s signature legislation for the year.

It was mostly just physicians and pharmacists in the General Assembly debating at the end, because they’re the only ones who really understood what an ICD-10 code is.

The bill, in its final form, requires doctors to provide the international diagnosis code on any opioid prescription more than three days. It’s meant to add a layer of accountability for the physician and helps the state collect more accurate data about how opioids are still being used as treatment.

But Sen. Mark Green, R-Clarksville, imagined the headache for emergency physicians like him, sifting through nearly 70,000 possibilities while trying to get to a patient down the hall.

“Some physician is about to run into a trauma, and they’ve got this administrative requirement that they’ve placed on them,” Green said, trying to convince senators to strip the clerical provision. “They’ve got to come up with an ICD-10 code and maybe look it up on the computer real quick or yell one out, hoping they remembered they’ve got the right one.”

The Senate added an amendment to the bill that removed the ICD-10 requirement but then reconsidered the decision after feeling pressure from the Haslam administration. Even the amendment’s sponsor, Majority Leader Mark Norris of Collierville, accused his colleagues of trying to sink the governor’s entire proposal.

“I didn’t realize how important it was, quite frankly,” Norris said. “I want you to know that it will kill the bill.”

Sen. Shane Reeves, R-Murfreesboro, is a pharmacist and acknowledged that the new paperwork will be a pain.

“I’d rather do too much at this point in time, and let’s see if we can’t get this crisis under control,” he said. “We can always back up in time.”

The provision remained in the final bill. Doctors would not have to provide the code for three-day prescriptions. Even still, Tennessee’s new law is one of the most restrictive in the country.

The Tennessee Medical Association, which represents doctors, worked with the administration throughout the year to alter the bill. And the lobbying group likes the final version better than the first. But TMA still has concerns about “unintended consequences.”

“Exploding use of fentanyl, heroin and other illicit drugs are causing more accidental overdose deaths even as opioid prescriptions decline,” TMA president Nita Shumaker said in a statement. “We still need a multi-faceted and well-funded strategy, including treatment and law enforcement, to turn back this epidemic.”