Parenteral controlled substance in ED

LuckyLily

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I would like to confirm that when coding E&M for the emergency department, when a patient gets a IM, IV, etc... of a controlled substance that it is a high level on the MDM risk.
 

LuckyLily

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There are two examples given in the Management Options of the MDM table.

-Parenteral control substances
-Drug therapy requiring intensive monitoring for toxicity

I want to know about the Parenteral controlled substances. Lyta2000 are you referring to the Drug therapy.
 

LuckyLily

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I was hoping that I would get more replies regarding Parenteral controlled substances that are given in the Emergency Department. For those E/M coders that do ED, is this an area that is not taken into consideration for the MDM risk?
 

pahenkel

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The drug has to be considered a controlled substance AND given by injection or infusion (parenteral) in order for it to be considered high risk.
 

nomerz

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Risk depends on the route of medication given, i.e. IV dilaudid is high risk while IM dilaudid would be moderate risk.

Does that answer your question?
 

SKPILLEY

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Sandra Pilley CPC, CPMA

On the table of risk, under the "high" category it lists "Parenteral Controlled Substances". I've googled the word "parenteral" and it is defined by several sources as: 1) administered or occurring elsewhere in the body than the mouth and alimentary canal. 2) Administered by some means other than oral or rectal intake, particularly intravenously or by injection. 3) medical Definition of parenteral. : situated or occurring outside the intestine. parenteral drug administration by intravenous, intramuscular, or subcutaneous injection ; especially : introduced otherwise than by way of the intestines.
Therefore, I would definitely count it as HIGH RISK if a controlled substance is given by IV or IM. Basically, as long as it is not being given by mouth, rectally, through a feeding tube, or other entrance/means directly into the digestive system.
 

paynejw83

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To be credited for high table of risk, "parenteral" controlled substances must be administered by this provider/team, must be a route that is not taken via alimentary tract, and must be on the FDA schedule of parenteral controlled substances, which can be found on the FDA site (updated as of 9/28/2020): https://www.ecfr.gov/cgi-bin/text-i...558e0cd&mc=true&node=se21.9.1300_101&rgn=div8, or, the direct link to the schedule of controlled substances is available (also on the FDA site) here: https://www.ecfr.gov/cgi-bin/text-i...0cd&mc=true&node=sg21.9.1308_103.sg1&rgn=div7 You can then use the "find" function and type in the substance you are looking for to see if it is on the schedule. Another option is to search the DOJ's DEA Division, which is slightly more user friendly: https://www.deadiversion.usdoj.gov/schedules/

This is different than the table of risk high category for "intense monitoring for drug toxicity" which is usually something that has regularly scheduled labs to check to organ dysfunction as caused by the drug. For that, Palmetto GBA (our local MAC in VA) has an excellent definition to meet this criteria, as well as drug examples: https://www.palmettogba.com/palmett... B~EM Help Center~General Articles~8EELEJ7715

I hope this helps!
Jessica Walter, CPC, CPMA, CEMA
Coding Improvement Coordinator
 

natashalage

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Thank you very much Jessica for this information! it is very helpful and I will share it in my huddle with other coders Thank you!
 
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