Risk Adjustment - Medication List


Monson, MA
Best answers
Hello, I have a question in regards to using a medication list in order to validate diagnoses reported within the record. If a patient has for example COPD in the PMH/PL list and it is not validated anywhere else in the note, but in the current med list, the medication Ventolin is documented, would you accept that as validation in order to report the COPD from the PMH/PL list? We have had several debates on this, and my issue is that unless its specifically linked that the Ventolin is being updates/renewed/reviewed for COPD condition, then we cannot assume and accept the COPD from the PMH list. I have the AMA Risk Adjustment book, it also states that we cannot code from the med list and that there should be a linkage between the medication and that condition.... Also a lot of medications have more than 1 indication, so if its not specifically linked for that condition, how can we assume that a medication is for that specific condition. I have been having a constant debate on a risk adjustment project in regards to this, so I am curious to what other coders think and if you have any specific references to back anything up I would appreciate that.

Thank you