Prescription Drug Management - reliable source

lmyers618

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Hi all,

Can anyone tell me where I can find documentation for Medicare, the AMA or other reliable source that will tell me (in the table of risk) how much value is given to prescrition drug management.

A patient that comes in the an urgent care and given a prescription. In the table of risk the prescription is listed a moderate level of risk, however if the nature of the presenting problen and final diagnosis may be a low level of risk.

This is difficult to explain this way, but I'm hoping one of you can help.

I need to find clear documentation (if at all possible) for educational puposes.

Can anyone help?

Thank you!!
 

lmyers618

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Thank you, Dawn.

That is good general information but I'm looking for something specific regarding the risk table and prescription drug managment. There seems to be two philosophies regarding prescription drugs and the table of risk. Some auditors view prescription drug as a moderate level of risk as it is listed in the table of risk, while others downcode if the chief complant is of low risk even though a prescription may have been given. I have been unable to locate a reliable source addressing this issue and hope that someone can provide documentation on this issue from a reliable source.

Thank you.
 

mmunoz21

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PRescription Drug Mgmnt

Hi,

I'm having the same problem..I know that all the audit tools direct drug management to "moderate" but if the #of diagnosis, and data reviewed are minimal then the MDM cannot be moderate. My superior who is an R.N. does not agree with the "moderate" theory for all RX management either and has asked me to get more insight too...

Thanks
 

dawndi67

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Hi,

I hope this helps. This is the information from the 1995 rules.

The following table may be used to help determine whether the risk of significant complications,
morbidity, and/or mortality is minimal, low, moderate, or high. Because the determination of
risk is complex and not readily quantifiable, the table includes common clinical examples rather
than absolute measures of risk. The assessment of risk of the presenting problem(s) is based on
the risk related to the disease process anticipated between the present encounter and the next one.
The assessment of risk of selecting diagnostic procedures and management options is based on
the risk during and immediately following any procedures or treatment. The highest level of risk
in any one category (presenting problem(s), diagnostic procedure(s), or management options)
determines the overall risk
.


Having a prescription alone does not raise the EM level it just raises the risk level to moderate.

good luck,
Dawn

PS this information is found on page 13 of the cms 1995 link given above.
 

colleenwade

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I agree that simply prescribing a medication does not make the MDM moderate. You must incorporate either the DMO or the Data from the MDM section. For example, a patient has stable HTN, labs are ordered and an Rx for an ACE inhibitor is given. DMO = 1 pt, Data = 1 pt and Risk = moderate. In this example, the level of MDM is Straightforward...
This information can be found in both the 1995 and 1997 CMS Evaluation and Management guidelines.
Hope this helps!
Colleen

Colleen A. Wade, CPC, CPC-H, CPC-E/M, CPC-I, PCS, FCS
Owner, Coding Healthcare Education and Consulting
"CHEC your educaiton needs with me!"
 
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