Sample SOMN Report

Kipu has a customizable narrative builder that makes it possible to populate the lab order request with client information from the facesheet and clinical information, including age, sober date, diagnosis codes, and current medication. Together with the chosen narrative, appropriate for the lab test being ordered, Kipu creates a unique Statement of Medical Necessity for each client.

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The Fully Integrated EMR Built For Addiction Treatment and Behavioral Health

Statement of Medical Necessity (SOMN)

Kipu Lab 2.0 gives you the tools to create unique Statements of Medical Necessity for each of your clients:

Populate client data from the face sheet
Add clinical information, including diagnosis codes, sobriety date, and current medication
Choose from a standard list of statements
Create unique narratives that meet your exact requirements

Kipu Lab 2.0 and the Medical Necessity Documentation Report™ (MNDR), are the key to proper documentation and higher reimbursements.

Statement of Medical Necessity for Definitive Testing

Kipu Health is proud to introduce its proprietary system for generating a Statement of Medical Necessity (SOMN)™ and the Medical Necessity Documentation Report™ (MNDR) as part of our Lab 2.0 interface.

The SOMN is a demonstration of the need for a course of treatment determined to be reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. We have programmatically created an engine to populate information into the Statement of Medical Necessity to document a unique statement. Kipu will pre-populate the following information from the patient’s chart:

Patient age
Patient gender
Diagnosis
Sobriety date, if documented
Currently used prescribed medications

Note: Kipu empowers a facility to track a patient’s sobriety date. Facilities can change that sobriety date when there is a positive test that indicates that a reset of the patient’s sobriety date is warranted. This is important as new guidelines indicate that a patient’s number of days abstinent is crucial in determining testing frequency.

PART ONE

Completing the Statement of Medical Necessity™

Kipu allows the facility to create buttons that, when clicked, will populate a Statement of Medical Necessity from a customized set of standardized justifications for testing. This will quickly and easily create a unique SOMN for each patient’s order.

Manually documenting a SOMN™

The Statement of Medical Necessity field is also a free-type field. If the facility needs to edit a prebuilt statement or add further information, simply click into the text and edit the information as needed. After the lab returns the result, the reviewing professional will sign the result, adding notes if needed. At this point, the reviewing professional may choose to make changes to the patient’s course of treatment – including prescribed medications and testing protocol – or may choose to discontinue testing altogether.

We’re including new enhancements which will tie the lab orders and results to treatment plan problems and objectives in Kipu’s Golden Thread®. Kipu also provides the MNDR™, a comprehensive history of the specimen from order to requisition, to result, through review, complete with your full Statement of Medical Necessity.

By Dr. Raymond Wasson: 37 year old male Client presenting with F10.10 Alcohol abuse, uncomplicated, F17.203 Nicotine dependence unspecified, with withdrawal, F11.10 Opioid abuse, uncomplicated, F19.20 Other psychoactive substance dependence, uncomplicated. Client indicates that he has been abstinent for 2 months and 2 weeks. Prescribed medications are Xanax, Vitamin B-12, Aqueous Vitamin E, Buffered Vitamin C, and Suboxone.

Placing Lab Orders.Create Lab test orders with a few clicks. Dropdown menus and checkboxes facilitate your choices.

Patient InformationClick on the “Patient Information” tab to populate patient age, gender, diagnosis and sobriety date from the facesheet. The current medications will populate from the “Doctor’s Orders.”

The “Intro” TabThe “Intro” tab houses an opening narrative to your Statements of Medical Necessity.

Toxicology TestingOnce the patient information and the introduction to the statement has been added, complete the Statement of Medical Necessity by adding a narrative, specific to the panel that is being requested.

PART TWO

Admission Confirmation Statement of Medical Necessity

37 year old male Client presenting with F10.10 Alcohol abuse, uncomplicated, F17.203 Nicotine dependence unspecified, with withdrawal, F11.10 Opioid abuse, uncomplicated, F19.20 Other psychoactive substance dependence, uncomplicated. Client indicates that he has been abstinent for 2 months and 2 weeks. Prescribed medications are Xanax, Vitamin B-12, Aqueous Vitamin E, Buffered Vitamin C, and Suboxone.

For admission of this client, a definitive confirmatory test is being ordered based on the clinical discretion of the ordering physician. A non-definitive immunoassay test is not considered adequate because it does not test for multiple substances that could have been used by the client. This definitive confirmatory test will not only provide conclusive evidence of any possible substances used by the client but will also determine the proper treatment program necessary. The result of this test is also vital to ensure the safety of this client, other clients at our facility and our facility staff members

PART THREE

Discharge Confirmation Statement of Medical Necessity

For the discharge of this client, a definitive confirmatory test is being ordered based on the clinical discretion of the ordering physician. It is vital to ensure that the client is free of any harmful substances and can be safely discharged or transitioned to another facility. A non-definitive immunoassay test is not considered adequate because it does not test for multiple substances that could have been used by the client. This panel is designed to detect any reasonably likely substance that may have been used by the client.

PART FOUR

Confirmatory Testing Statement of Medical Necessity

A definitive confirmatory test is vital for clinical and therapeutic purposes, it is intended to confirm the use of prescription medications and illegal substances. Drug overdose deaths in 2016 exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times. The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made deadlier by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50. Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.

The coast-to-coast opioid epidemic is swamping hospitals, with government data from the Agency for Healthcare Research and Quality (AHRQ), reporting 1.27 million emergency room visits or inpatient stays for opioid-related issues in a single year. This reflects a 64 percent increase for inpatient care and a 99 percent jump for emergency room treatment compared to figures from 2005. This trajectory likely will keep climbing if the epidemic continues unabated. Adding to the overdoses from heroin and prescription opioids has been the spread of the synthetic opioid fentanyl, which can be mixed with heroin or cocaine and is extraordinarily powerful. Several states have declared a state of emergency in response to the crisis.

Point of CollectionCreate orders for POC testing inside of your Kipu Instance and record the results.

Complete Screen and Confirmation of Positive Result:Verify presumptive test results with confirmatory testing by combining them into a single order.

PART FIVE

Ongoing Testing Statement of Medical Necessity

We create our test protocol using evidence-based guidelines and professional clinical consensus. The Statement of Consensus on the Proper Utilization of Urine Testing in Identifying and Treating Substance Use Disorders was published in March of 2014. This consensus statement was created by nine of the foremost experts in the field of addiction medicine and was based on the most up to date evidence. These experts are among the most reputable in regard to developing appropriate policy for addiction medicine, including the Immediate past president of ASAM, a former president of ASAM, and physician faculties from both Yale University School of Medicine and University of Florida College of Medicine.

According to these experts, “this document is intended to provide clinically relevant information that practitioners, payers, and policymakers may use to familiarize themselves with urine testing to identify and treat SUDs.” The consensus conclusion is as follows: “When properly utilized, substance use testing can be a useful tool in the diagnosis, treatment, and recovery of SUDs. Yet, no clinical guidelines currently exist for substance use testing in addiction medicine, and a lack of knowledge, unethical behavior, and ill-advised cost-saving measures have resulted in confusion and imbalances in the utilization of such services. In response to these issues, a panel of experts convened to create this consensus statement. It is the hope of the panel members that this consensus statement will improve the utilization of substance use testing by providing health care practitioners in all areas of practice with recommendations on test selection, analysis, and appropriate responses to test results in each stage of SUD treatment.” The following represent the consensus “General Guidelines for Active Treatment” of substance abuse: “When a patient is in active treatment, testing should be conducted, to the extent possible, on a regular basis and at random intervals, to reduce the likelihood that the patient could successfully plan to undermine the test results.

If the patient has gone 30 days or less without use, perform preliminary and definitive tests one to three times per week as follows: at least one in three of these tests should be a definitive test and if a preliminary test indicates use, follow up with a definitive test. If the patient has gone 31-90 days without use, perform a preliminary test one to three times per week. If a preliminary test indicates use, follow up with a definitive test and perform a definitive test one to three times per month. If the patient has gone 91 days to two years without use, perform a preliminary test one to three times per month. If a preliminary test indicates use, follow up with a definitive test and perform a definitive test one to three times per every three months. If tests indicate use, at any point, the clinician should resume the testing schedule recommended for 30 days or less without use, and treatment may need to be adjusted or intensified.”

Patient Compliance:Verify compliance with treatment according to protocol, on return to facility or prior to group sessions.

PART SIX

Random Schedule Statement of Medical Necessity

This urine drug test is being ordered based on the clinical discretion of the ordering physician. According to the October 2013 ASAM White Paper on Drug Testing, “It is ASAM policy that the elements of drug testing (e.g., matrix, drug test panel, testing technology) be determined by the ordering physician based on patient-specific medical necessity. Arbitrary limits on reimbursement and restrictions on drug testing can interfere with a physician’s judgment and instill discriminatory limits on addiction care.” The choice of substances that we test for are based on the individual patient situations combined with the most up to date evidence. According to the ASAM National Practice Guideline published in May of 2015, “Urine drug testing, or other reliable biological tests for the presence of drugs, during the initial evaluation and frequently throughout treatment is highly recommended.” This is the accepted standard of care for all patients with recent active substance abuse.

Review and Sign Lab Results:All negative lab test results can be signed in a single batch. Abnormal results must be individually acknowledged and signed. Enter a note to document how the test result will influence treatment, and any planned changes.

PART SEVEN

Monitor Group Session Statement of Medical Necessity

This urine drug test, ordered for diagnostic, clinical, and therapeutic purposes, is intended to detect the use of prescription medications and illegal substances. The results are necessary to assess this client, to guide treatment and monitor compliance with medication protocol as dictated by the treatment program. This client will be tested as per the determined frequency, as part of routine monitoring, prior to attending groups, randomly, or under suspicion of relapse, according to this facility’s policies and procedures. Medical Necessity for Definitive Drug Testing is imperative for this patient.

PART EIGHT

Suspicion of Use Statement of Medical Necessity

Presumptive testing (screening or preliminary testing) using immunoassay (IA) technology yields rapid results and together with patient history influences immediate decision making. Some clinical decisions can be made using presumptive testing alone, a cost-effective and objective test, but at times more detailed information is necessary to make effective clinical decisions. In the case of this patient, definitive testing (formerly known as confirmatory testing) is crucial to obtain vital, accurate results that will directly influence clinical management. As stated in a presentation by Stuart Gitlow, MD, MPH, MBA, the immediate prior president of the American Society of Addiction, “IA will often lead to negative results even with substance use. Klonopin and Ativan will not generally show up on benzodiazepine screening. Similarly, Dilaudid and Vicodin may not show up on opiate screening.”

When patient history in combination with presumptive testing (via IA) does not provide a complete clinical picture, it is medically necessary to order a definitive test (via LC-MS/MS or GC/MS) to not only confirm results but to reveal the presence of drugs not reliably detected by IA tests. IA testing relies on competitive binding of an antibody to detect the presence of a specific drug or metabolite in the urine but fails to distinguish drugs of the same class. EIA cross-reactivity across a drug class is limited, especially in the case of opiates, benzodiazepines, and barbiturates. Opiate immunoassay screens typically target codeine and morphine; semisynthetic opiates such as hydrocodone and oxycodone may react at high concentrations or not at all. In cases of limited cross-reactivity, false-negatives is a concern.”

Patient history combined with presumptive testing may not provide clinicians with enough information to make appropriate safe decisions regarding patient care. Pain Physician 2012; 15: ES119-ES133 • ISSN 2150-1149, urine drug testing: current recommendations and best practices says that “results from immunoassay testing must be considered preliminary and cannot be considered conclusive until confirmatory testing has been performed. Failure to send EIA urine for confirmatory testing is a poor practice.” After careful consideration, we continue to believe that ordering definitive tests for all clients is not clinically necessary or cost-effective and we understand that the system has been abused. We are committed to testing only when clinically indicated, we do so in an economically responsible manner and continue to base our decisions on an individual basis for each client.

Sample SOMN Report

Statement of Medical Necessity (SOMN)