Fresno, CA
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So I have mixed thoughts on the MDM area for what can qualify as drug therapy requiring monitoring. I know the guidelines of what drugs qualify, however what about patients that are on radiation therapy or chemotherapy and we are continuing the same treatment with no changes. Does this still qualify towards the MDM of that day of service since we aren't making any changes. To me, it sounds straightforward since no new decisions are being made and the therapy itself already includes follow up of the drug. One webinar stated that any ongoing treatments and/or medications can not be counted towards the day of the encounter if no changes or new discussions about it are being made. Does anyone have any thoughts on this? All examples that I am finding have to do with new start meds or change in dosage, etc. None apply to continuing same plan and treatments.
For drug therapy requiring intensive monitoring for toxicity/adverse effects, a few criteria need to be met. First, the monitoring has to be AT LEAST quarterly. The monitoring has to be to check for toxicity and not for efficacy.

In regards to the decision regarding drug management, that decision can be negative or positive, as I understand it. Therefore, if a patient is on chemotherapy, the provider would need to decide whether to continue treatment without any changes or to make some changes. Either decision counts as prescription drug management.

In the assessment/plan, the physician can make a note as to what they're doing with the drug management.

For example, for a patient on drops for glaucoma, the OD could write a note such as: "IOP OU not at goal pressure of 14 OU with latanoprost. However, patient reinstructed on importance of using drops daily. Recheck IOP in 4 weeks, if IOP not reduced to goal pressure, may consider adding/changing medication."

If the current medications are not addressed in the A/P, then prescription drug management couldn't be counted for coding the exam.

Tom Cheezum, OD, CPC, COPC