Wiki e/m for medication management

[meghanduggan]

I have a doctor who has been trying to submit 99214 e/m patient was seen via telehealth for 11 minutes.

the cms guidelines I found state flat out that just LISTING the medications the patient is taking is not sufficient enough to warrant an e/m code. The patient takes over 20 medications. Aside from the list of the medications, the doses and the means of taking the medications the only note I can find from the provider is this. I don't feel that this is enough to warrant such a high e/m. Does anyone have any good guidelines or blogs I can read on this?



(F33.1), Chronic Moderate
Impression - working diagnosis; bipolar d/o vs personality disorder complicating unipolar depression;. Differential Diagnosis - add, bipolar
Borderline personality disorder (F60.3), Chronic

Impression - included in differential diagnosis; has responded well to medications so far; will continue to move forward with medication mgment and addressing potential ddx as well as barriers to improvement as they develop.
(F40.01), Chronic Moderate
Impression - stablization of symptoms; pt does not feel the need for med adjustment at this time.

 

[lgardner]

per Noridian (emphasis added by me):

Q7. What are the guidelines regarding prescription drug management in the MDM?
A7. Credit is given for prescription drug management when documentation indicates medical decision making for the management of a prescription drug by the physician who is rendering the service. Medical management could include a new drug being prescribed, a change to an existing prescription, verification of any side effects or problems with the drug, or simply refilling a current medication. The drug and dosage must be documented as well as the drug management.

from the documentation you've provided, this would not be counted as Prescription Drug Management.

a coder cannot pull this information from the problem list or the medication list; the drug, dosage and drug management must be documented by the provider and linked to a diagnosis.

 

[jkyles]

Too bad there isn't detail for this bit "pt does not feel the need for med adjustment at this time." You would be in good shape. I think it is obvious there was a discussion with the patient, but just as obviously the doctor didn't document it so it doesn't help.

As an aside, the time doesn't matter if you're coding based on MDM.

 

[1formissy]

Tagging onto this. I agree that Rx management is ONLY counted if the medication that requires prescriptive authority is evident on the documentation. Listing the medications does NOT warrant a moderate complexity. Now, I am going to throw this out there! I am currently studying the CEMC exam prep, and one question I failed at said the risk is moderate due to prescription drug management. I said, no it does not and here are the guidelines saying such. AAPC came back and said they understand payers have different coding concepts but for this exam this is how it will be coded. All the question did was LIST the RX, so I said LOW complexity for RISK. AAPC said nope, I am wrong. So, see how CONFUSING this is for us? I have been doing this line of work for 19 years now, and I decided to take the CEMC just to have another nice notch in my belt. However, when we come across things like this, it makes me question the integrity of the exam. The real stink of it is, how can one know what questions we failed on, if we are not allowed to see? So we will NEVER know if we answer a question correctly according to guidelines, and AAPC decides it is not the correct answer.

Sorry to vent, but I seen this post, and yes, RX management is not listing the RX alone. I would defer your provider to the guidelines.

 

[shirleyharris]

Tagging onto this. I agree that Rx management is ONLY counted if the medication that requires prescriptive authority is evident on the documentation. Listing the medications does NOT warrant a moderate complexity. Now, I am going to throw this out there! I am currently studying the CEMC exam prep, and one question I failed at said the risk is moderate due to prescription drug management. I said, no it does not and here are the guidelines saying such. AAPC came back and said they understand payers have different coding concepts but for this exam this is how it will be coded. All the question did was LIST the RX, so I said LOW complexity for RISK. AAPC said nope, I am wrong. So, see how CONFUSING this is for us? I have been doing this line of work for 19 years now, and I decided to take the CEMC just to have another nice notch in my belt. However, when we come across things like this, it makes me question the integrity of the exam. The real stink of it is, how can one know what questions we failed on, if we are not allowed to see? So we will NEVER know if we answer a question correctly according to guidelines, and AAPC decides it is not the correct answer.

Sorry to vent, but I seen this post, and yes, RX management is not listing the RX alone. I would defer your provider to the guidelines.

I experienced the same with the CRC. The only exam I've taken where I was disappointed with my score, even though I did pass. During the exam prep I kept getting questions marked wrong where the documentation was not in the impression and plan, but within the problem list or medication list. The example cited above would qualify for Rx management per my understanding during that process- physician statements "move forward with medication managment", "pt does not feel the need for med adjustment" and a Medication List was present.

 

[1formissy]

I experienced the same with the CRC. The only exam I've taken where I was disappointed with my score, even though I did pass. During the exam prep I kept getting questions marked wrong where the documentation was not in the impression and plan, but within the problem list or medication list. The example cited above would qualify for Rx management per my understanding during that process- physician statements "move forward with medication managment", "pt does not feel the need for med adjustment" and a Medication List was present.

Now that's confusing to me because we cannot assume that the problem list or medication list is the impression and plan. I would never think that the problem list would be part of the assessment and plan. Then again, thank you for that insight because I would not be surprised to see it on one of the two exams I am prepping to take. CEMC, and CDEO. Glad to hear that you passed. Congratulations!