Inpatient follow up and Parenteral control substances

vnascimento

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Hello,

When dr. is performing an inpatient follow up visit and he states the current IV medication, dose and frequency and states " Continue the same". Is it considered High Management Option? I often choose Moderate ( in my line of thought, he is managing the drugs). On the other hand, if he order the IV, adds another drug or changes the dose, I choose High Management Option Selection.

Can anyone help me with this dilemma. One of the doctors that I code for believes it should be high as long as patient is on IV controlled substances. But I can't find any information that would support either way. The Risk of complication table only states "Parenteral controlled substances".

Please help me
 
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clbarry8033

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I usually count the continuance of parenteral controlled substances in the high category on the table of risk. My rationale is the doctor must make the decision to keep them on that drug. Let me know if you find out any different!
 

vnascimento

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Thank you for your rationale. Let see if more people will give some thoughts on this.
 
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You have to remember that subsequent hospital care services are based on an interval history/exam/MDM.

Medication risk depends on things like the route of administration, the type of drug, and the potential for adverse effects, in addition to the specifics of that particular patient (based on their condition, etc). The risk for a particular medication doesn't change regardless of whether the dosage is continued, increased, or decreased. If a medication is high risk, it will always be high risk.

My local MAC states "Prescription drug management is for managing the drug regimen. This is not just a listing the patient's medications. It is for new drugs prescribed, evaluation and raise or lower drug dosages, etc."
 

thomas7331

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The NGS MAC in our area defines prescription drug management as 'continuation & new prescription', so continuing medications would qualify for that definition, which is moderate risk. The high risk categories are qualitatively different - 'parenteral controlled substances', which is not just any IV medication but specifically controlled substances, i.e. narcotics, or 'drug therapy requiring intensive monitoring for toxicity'. I would not assign high risk based on 'continue current medication' unless the provider has documented some additional evaluation or management specific to the patient's condition that supports a higher level of risk and MDM. Remember that the table of risk is 'intended to be used as a guide' - the entirety of the documentation and the nature of the presenting problem should also be considered.
 
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