While most health care settings have established processes and procedures for patient screening of health conditions such as high blood pressure, cholesterol, breast or prostate cancer, etc., drug abuse screening in general medical settings involves additional practical considerations:^8,9

• Determine staffing roles, including who will administer the screening instrument; discuss results with patients; and intervene and/or refer when necessary.
• Train designated staff to conduct screening, intervention, and referral.
• Decide how screening results will be used and develop a procedure for handling positive and negative results. Note: Screening is not a full assessment; refer patients for a full assessment if a problem is indicated by the screen or through discussion with the patient.
• Apply existing office procedures to screening practices, including patient documentation, consent procedures, confidentiality and HIPAA procedures, storage of records, and patient flow.
• Obtain reimbursement information for your State.
  • In 2007, the Centers for Medicare and Medicaid Services (CMS) adopted new codes for alcohol and substance abuse assessment and intervention services in the Healthcare Common Procedure Coding System (HCPCS).
  • In January 2008, the American Medical Association (AMA) adopted Current Procedural Terminology (CPT) codes for screening and brief intervention, and new Medicare “G” codes became available that parallel the CPT codes.
• Establish relationships and linkages with external providers who will accept referrals for additional assessment and/or drug treatment.
• Consider patient reading level when providing educational and support materials. Because it is often difficult to determine reading level, particularly in emergency room situations, consider using materials developed for an 8th grade reading level.
• Deal with severe, immediately lifethreatening medical consequences of substance abuse as you would any other medical emergency.
  • If same day substance abuse treatment assessment is not available, transfer patient to the emergency room or admit to the hospital.
  • Arrange alternative transportation for patients under the influence of drugs, alcohol, or medication that would impair their driving. For these patients, the brief intervention should focus on crisis management.