Wiki I would not give credit for this as Prescription Rx Mgmt. Just checking... agree ?

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GJackson

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Pt is coming in for new pt visit and gets a 20610 joint injection, in the providers documentation they are stating " that the risk should be moderate because they have given an injection and its documented above and that is prescription drug management. " I do not consider this prescription drug mgmt, and actually I think that would be double dipping and we are charging when appropriate the OV and the injection procedure... Just asking if other coders agree? Now if they actually write a script of course I would give credit when documented... thanks ?
 
Hi there, perhaps I'm missing something but where's the prescription?

Also, the provider must document their medical decision making if that's what they're using to code an E/M visit. "Here's what I did" isn't the same as "Here's why I did it."
 
I've had this scenario as well. The provider should state what the risk is for a patient taking a one time dose of an rx drug in a healthcare setting. I don't consider it medication management, but they also don't say there's a moderate risk of disease or death, because______________. OR it's low risk- patient comes in with an exposure to an STI- provider only treats empirically with ceftriaxone. Provider does not document the risk(of a one time dose while there as low, moderate, high etc. 99212- Now the same scenario, but somebody else is giving the history because the patient can't speak (documentation girlfriend giving the history) it's a level 3, Just me?
 
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