Prescription Drug Management

[TEDWAR08]

Can you tell me if administration of a drug in the office (Kenalog, Rocephin for example) qualifies in the MDM risk table as prescription drug management? I would appreciate any reputable resource that provides guidance.

 

[OCD_coder]

Prescription drug management typically is understood for drugs that are NOT over-the-counter types of drugs. Since OTC drugs are consider low risk, prescription drugs would be moderate, then we have drug that require toxicity monitoring to be High. Some internal coding policies have defined even further to include prescriptions for topical drugs to be at the OTC level, just to be aware.

Here are a few sources for prescription related topics, but not necessarily specific to your question:
http://wpsmedicare.com/j5macpartb/resources/provider_types/2009_0608_evalmngmntqamdm.shtml
Q8. The 1995 and 1997 DG show "prescription drug management" in the Moderate level of risk. Do I have to write a new prescription to qualify for this level of risk?

A8. A new prescription is not required for this level. The medical record documentation must show you are either writing a new prescription for the patient or evaluating any current prescriptions, including determining whether the drug, dosage, and frequency are still appropriate for the patient's condition.

Q9. What is the difference between "prescription drug management" for the moderate level of risk and "Drug therapy requiring intensive monitoring for toxicity" in the high level of risk?

A9. Prescription drug management is where a provider is either writing a new prescription for the patient or evaluating any current prescriptions, including determining whether the drug, dosage, and frequency are still appropriate for the patient's condition. Intensive monitoring for toxicity is evaluating the possible harmful effects of a toxin or poison prescribed for or used on the patient. The most common example is chemotherapy drugs.

http://www.physicianspractice.com/coding/prescription-drug-management