Part B Insider (Multispecialty) Coding Alert
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As most E/M coders are aware, drug therapy requiring intensive monitoring for toxicity is considered a high risk management option in the table of risk, and applies to the physician’s work ensuring that patients’ drug levels stay at safe levels.
However, if you’re giving yourself extra points on the table of risk just because your patients are on drugs likely to cause toxicity (for instance, chemotherapy), you may want to re-check the doctor’s documentation to ensure he deserves the points.
“In order to receive ‘credit’ for drug therapy requiring intensive monitoring for toxicity, you must manage/monitor the drug,” Part B MAC Palmetto GBA says in a Feb. 6 E/M Weekly Tip. In other words, the patient merely being on the drug isn’t enough to qualify for the points—you must be the practitioner actually managing and monitoring it.
Palmetto expects to see “documentation in the medical record of drug levels obtained at appropriate levels” to demonstrate your work monitoring the patient to prevent toxicity, the payer says in its article “Drug Therapy Requiring Intensive Monitoring for Toxicity.”
To read more about Palmetto’s requirements, visit the MAC’s website at www.palmettogba.com.
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