Cardiology Coding Alert

Question: I find the medical decision making Table of Risk tricky to use. Where would management of amiodarone fall under Management Options Selected?

Texas Subscriber

Answer: Experts suggest ticking the "high risk" box for visits related to amiodarone, as it matches that category's listing for "Drug therapy requiring intensive monitoring for toxicity."

The drug is used to treat patients with life-threatening ventricular arrhythmia or atrial fibrillation (427.x, Cardiac dysrhythmias), but it is known to have multiple potential side-effects due to toxicity. Some of the areas affected include the lungs, liver, thyroid, eyes, skin, and nerves. Additionally, the drug is known to interact with many other medications and nutritional supplements.

As a result, the cardiologist has to carefully monitor the patient for serious side effects and potential drug interactions to a degree that meets the Table of Risk's "intensive monitoring" requirement.

Remember: Meeting high risk isn't enough to decide the medical decision making (MDM) level for the E/M is high complexity. You also must meet the requirements for either:

• An extensive number of diagnoses or management options
• An extensive amount or complexity of data to review.