High-Risk Medications for Rheumatology
Based on the retrieved documents, here are some high-risk medications commonly associated with rheumatology:
- Glucocorticoids:
- Prednisone (especially doses > 5 mg daily for longer than 6 months)
- Methylprednisolone
- Dexamethasone
- Narcotics (includes combination medications):
- Meperidine
- Propoxyphene
- Pentazocine
- Oral Estrogens:
- Conjugated estrogen
- Esterified estrogen
- Skeletal Muscle Relaxants:
- Cyclobenzaprine
- Carisoprodol
- Methocarbamol
- Oral Hypoglycemics:
- Chlorpropamide
- Others:
- Belladonna alkaloids (e.g., atropine)
- Vasodilators (e.g., dipyridamole)
Considerations
- Long-term use of glucocorticoids should be monitored due to potential health complications such as osteoporosis, hypertension, and increased risk of infections.
- The adverse effects of these medications should be discussed with patients prior to initiation of therapy.
I would question this list, and many payors would do so as well. Inflating the "monitoring" of drugs to get to Level 5 E&M is a recipe for audits and clawbacks.
CPT's definition of monitoring:
"A drug that requires intensive monitoring is a
therapeutic agent that has the potential to cause serious
morbidity or death. The monitoring is performed for
assessment of these adverse effects and not primarily for
assessment of therapeutic efficacy. The monitoring should
be that which is generally accepted practice for the agent
but may be patient-specific in some cases. Intensive
monitoring may be long-term or short-term. Long-term
intensive monitoring is not performed less than quarterly.
The monitoring may be performed with a laboratory test,
a physiologic test, or imaging. Monitoring by history or
examination does not qualify."
Most of the drugs mentioned above, if not all of them, do not meet these criteria for monitoring, as they do not usually require quarterly labs or physiologic tests.