Prescription Drug Management


Local Chapter Officer
Alvin, TX
Best answers
I have always been taught that a single prescription, for example one time prescription of Toradol for a shoulder strain, does not mean that this is Prescription Drug Management.

I am having an issue with a fellow coder that is stating it is. I found an article stating "The mere presence of prescription drugs does not necessarily qualify for moderate complexity. CMS has indicated that writing a prescription for a seven- or 10-day supply of an antibiotic is not considered to be a moderate level of complexity. At least one Blue Cross company has indicated that prescription drug management involves more than the use of prescription drugs. It may mean a change in regimen, the addition of an agent, or the worsening of a problem."

The link is

Can anyone tell me if they have ever seen this statement (or indication) on the CMS Website? I have just spent the last 2 hours searching and cannot find it.

Appreciate any help I can get for this.


True Blue
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CMS has not issued any recent clarification to this that I'm aware of but you may want to check with your local Medicare carrier. However, the original 1995 document guidelines do state that "because the determination of risk is complex and not readily quantifiable, the table includes common clinical examples rather than absolute measures of risk" which I think is a pretty clear statement that you can't take any one example off of the risk table and apply it to every situation.

I worked recently with a consultant who did audits throughout the country and she advised me that most payers nowadays generally consider the writing of a single prescription with no other complicating factors to be in the 'low' risk category.