Wiki OTC Prescription Increasing Coding

[Sarahp941]

We use a EMR software. Prescription and Prescription Management was programmed as "Moderate" risk. I am now finding my Providers using Prescription for OTC meds, whether insurance covers them or not. But by using this plan with a chronic condition, it pulls a level 4. I am trying to find documentation or information on this grey area. Many articles I read say the Provider's discretion on whether the medication is considered Low or Moderate risk, based on chronicity of the diagnosis. But of course when you leave it to a Provider, they don't always document properly or they think everything is justified because they "prescribed" something. CMS says " "Prescription drug management" is based on documented evidence that the provider has evaluated the patient's medications as part of a service. Credit is given if the documentation clearly indicates medical decision-making took place regarding the medication(s). This may be a prescription being written or discontinued, or a decision to maintain a current medication/dosage." But nothing is talked about for OTC drugs. Our patients may have skin redness or xerosis and we order/recommend Dermend or Amlactin lotion, which is OTC. But since we documented the prescribing portion, it counted towards management. I am confused and other posts I have seen throughout this forum are also not clear. Any help is greatly appreciated! Thank you.

 

[arozance27]

OTC is a low level of risk.
Prescription medications moderate risk.
This is per the AMA table.

 

[csperoni]

This was a duplicate post, and there was a discussion here.
Summary:
OTC is typically low level risk. There could be situations where OTC is more than low risk, but would need context and documentation of such.