E&M Auditing the Risk

lblakeley

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I have some conflicting information when it comes to the risk portion in the MDM. I don't consider giving an antibiotic a moderate risk. Some coders and auditors say it is other say no. Does anyone know if it really is a moderate risk? My theory is that they are not managing a medication such as Nadolol, Coumadin or other drugs that require monitoring. They are just writing the script it's a one time prescription.
 

mhstrauss

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I have some conflicting information when it comes to the risk portion in the MDM. I don't consider giving an antibiotic a moderate risk. Some coders and auditors say it is other say no. Does anyone know if it really is a moderate risk? My theory is that they are not managing a medication such as Nadolol, Coumadin or other drugs that require monitoring. They are just writing the script it's a one time prescription.

Writing prescriptions, including antibiotics, does fall under the Moderate Risk in MDM. The others you mention, ie. that require monitoring for toxicity, are High Risk.
 

mhstrauss

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Thanks Meagan. Do you have any CMS guidelines to back this statement. I need to clarify this by CMS standards. Thank you:eek:

CMS has the 95/97 Documentation Guidelines showing this info for the Table of Risk. You can check with your MAC to see if they have more specific info; here is an example of a Q&A from WPS--see #'s 8 & 9:

http://www.wpsmedicare.com/j5macpartb/resources/provider_types/2009_0608_evalmngmntqamdm.shtml

You can also try googling "table of risk prescription drug management" for other reliable references.
 
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