Determing the complexity of E/M codes

SWall

New
Messages
7
Best answers
0
I am struggling on figuring out the complexity.

When a physician says " continue current medicine" Or just list medication like " coreg bid" or flonase otc prn. Would you cod ethis as Moderate (presscription drug management?
 

Bernadette10

Networker
Messages
74
Best answers
0
I think the above example is more just listing the medication and doesn't really show management of it and would not give moderate risk for that alone.

https://medicare.fcso.com/faqs/answers/0324049.asp
What constitutes prescription drug management?

Q. During an evaluation and management visit, what constitutes “prescription drug management?”
A. “Prescription drug management” is based on documented evidence that the provider has evaluated medications as part of a service, in relation to the patient. This may be a prescription being written or discontinued, or a decision to maintain a current medication/dosage.
Note: Simply listing current medications is not considered “prescription drug management.”

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00005056
When can prescription drug management be credited in the Medical Making Risk of Complications chart?
Credit is given for prescription drug management when documentation indicates medical management of the prescription drug by the physician who is rendering the service. Medical management includes a new drug being prescribed, a change to an existing prescription or simply refilling a current medication. The drug and dosage should be documented as well as the drug management.
If medications are just listed in patient’s medical record, credit is given for past history.
 

thomas7331

True Blue
Messages
2,280
Best answers
5
I agree, and from what I've heard from experienced auditors, most payers will not allow an order for a prescription or a statement to 'continue' a current medication, in and of itself, to qualify for moderate risk or moderate MDM. As a general rule of thumb, many payers and auditors consider a visit which involves a single problem, and for which a single prescription is issued, to be limited by medical necessity to a level 3 E&M code at the maximum, unless there are other complicating factors documented.
 

twizzle

True Blue
Messages
1,182
Location
Sarasota FL
Best answers
0
I agree, and from what I've heard from experienced auditors, most payers will not allow an order for a prescription or a statement to 'continue' a current medication, in and of itself, to qualify for moderate risk or moderate MDM. As a general rule of thumb, many payers and auditors consider a visit which involves a single problem, and for which a single prescription is issued, to be limited by medical necessity to a level 3 E&M code at the maximum, unless there are other complicating factors documented.
As an auditor I have never considered 'continue current medication' to constitute Rx drug management and moderate risk. There is little risk involved because the provider knows the patient is tolerating the drug and the dosage without side effects, the drug is doing it's job etc, unlike changing a drug and /or a dosage where there is clearly more risk.
 
Messages
1
Best answers
0
As an auditor I have never considered 'continue current medication' to constitute Rx drug management and moderate risk. There is little risk involved because the provider knows the patient is tolerating the drug and the dosage without side effects, the drug is doing it's job etc, unlike changing a drug and /or a dosage where there is clearly more risk.
Further question on managing Rx drugs - Our providers are divided on this issue when it comes to this instance: Having a patient discontinue a medication that we did not prescribe, for several days prior to our doing a procedure and then having them restart once procedure is done.
Example: Anticoagulation and we will do a colonoscopy (we're a GI group). We see the patient in the office prior to the procedure due to the comorbidity.
Would you think doing that constitute management of Rx?
 
Messages
3
Best answers
0
When a provider prescribes Tylenol 500 mg with a script, would you classify that as medication management (Moderate MDM), as this is an OTC medication that can be obtained without a script? Or Ibuprofen 800 mg; where you cannot obtain those mg without an prescription, however you can get Ibuprofen 200 mg and just take 4 pills to have the same mg dosage? Any thoughts would be helpful! Thank you!
 
Top