MDM - Prescription Management

KIMST1977

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I have a question about prescription management for medical decision making (MDM). I was recently told by a co-worker if a provider prescribes a "short term" (0-10 day) medication, the MDM becomes Low. It has always been my understanding prescription management falls into Moderate MDM. Has anyone else heard of this? If this is correct can you also point me to where I can locate this information in writing?
 

twizzle

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Your co-worker is not entirely correct and you will find nothing in writing to support it unless it is a client-specific guideline. I have known clients whose guidelines might say that for a short (7 day) course of antibiotics for an acute uncomplicated problem, the MDM is low. Others say that any Rx drug management carries a risk and that is certainly true.
Your co-worker is saying that a Rx for an opiate drug for up to 10 days is low risk which is clearly ridiculous. These drugs carry a high risk of addiction as we all know.
As a very general rule you should view Rx drug management as moderate MDM but specific clients may have specific policies. Check with them first and always be wary of what your co-workers say.
 

Pathos

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Another way of thinking about this: imagine your clinic is selected for an audit and the chart you are auditing is in question. If the MDM is being questioned, you will need to provide solid references as backup to support your MDM level. The words of a co-worker, or even your coding manager will not hold up in such a situation. However, clear references from CMS, AMA, or relevant AHA Coding Clinics could provide a strong case for your argument.
 

Sarah Ann

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You are correct- the duration of the RX does not have bearing on the complexity- treatment options RX drug management-mod. mdm.
 
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Generally there is some kind of rule within your coding establishment. For instance, in Family practice if you always use MDM for prescriptions being given. With the new EMR all patients would be a level 4. That is not realistic and will come back to bite you. When you get to the end of the note. you always have to ask yourself was the documentation pertinent to the problem that the patient was being seen for. If the patient has an earache and is of school age. is it pertinent to do a comprehensive exam? or History? Is the medication that is being managed of a high risk nature or long term? There is a lot that goes into coding.
 

medicalauditor

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I have a question about prescription management for medical decision making (MDM). I was recently told by a co-worker if a provider prescribes a "short term" (0-10 day) medication, the MDM becomes Low. It has always been my understanding prescription management falls into Moderate MDM. Has anyone else heard of this? If this is correct can you also point me to where I can locate this information in writing?
The level of MDM is determined based on 3 elements, not just 1. So anyone who is saying the prescription drug management alone can decide what level of MDM it is, is wrong. The 3 elements are: 1. Number of diagnoses/management options 2. Amount and/or complexity of data reviewed 3. Table of Risk. For the 1st 2 elements, there are several components, based on which you would calculate the points in each element. Then under the 3rd element, which is 'table of risk', prescription drug management falls under 'moderate' level of risk. But this is just 1 of the elements, this does not decide the overall MDM. For overall MDM to be moderate, at least 1 of the other 2 elements would have to have total point value of 3 or more. So as you can see, calculating MDM involves a little more than just the prescription. Here is a link to AAPC's E/M audit tool that will help. http://static.aapc.com/ppdf/Audit_tool3.pdf
 
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