Wiki 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.
 
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.
 
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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