zaidaaquino
Guru
One of the bullets for the Risk portion of the E/M MDM selection is for "prescription drug management." Is a refill of a medication still considered drug management?
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Wiki RX REFILLS
- Thread starter zaidaaquino
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flowergrl
Contributor
In my experience, some coders/auditors count that and some don't. I've run into a TON of grey area here, and have struggled to get a straight answer to this question many times.
I've heard some say they count anything to do with a prescription med as 'drug management'. Such as a. starting a new med, b. changing a dosage of a current med, c. refilling a current med, d. advising to continue a current med (with no changes) and e. stop/hold a med.
I've also heard some say they only count it if its 1. starting a new med, or 2. changing a dosage of a current med or 3. stop/hold a med. That refilling or telling a patient to continue a current med is not actually 'decision making' that is medically necessary.
So I will be interested to hear what others are doing.
I've heard some say they count anything to do with a prescription med as 'drug management'. Such as a. starting a new med, b. changing a dosage of a current med, c. refilling a current med, d. advising to continue a current med (with no changes) and e. stop/hold a med.
I've also heard some say they only count it if its 1. starting a new med, or 2. changing a dosage of a current med or 3. stop/hold a med. That refilling or telling a patient to continue a current med is not actually 'decision making' that is medically necessary.
So I will be interested to hear what others are doing.
Cynthia Hughes
Expert
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This answer from Medicare Part B Administrative Contractor, First Coast Service Options, may state it best.
A. "Prescription drug management" is based on documented evidence that the provider has evaluated the patient's medications as part of a service. This may be a prescription being written or discontinued, or a decision to maintain a current medication or dosage."
To say a bit more from an auditing perspective, there should be documentation supporting that the physician made a decision to continue the medication at the same dosage vs. reviewed a list of the patient's medications without evaluating the patient's current condition and making a decision on the appropriate management. Often this is found in the assessment and plan such as: diabetes type 2, improved A1c, continue Metformin as prescribed, refill ordered.
Cindy
Sorry this came out in all bold font. Not sure why.
"E/M FAQ -- What constitutes prescription drug management?
Q. During an evaluation and management visit, what constitutes "prescription drug management?"A. "Prescription drug management" is based on documented evidence that the provider has evaluated the patient's medications as part of a service. This may be a prescription being written or discontinued, or a decision to maintain a current medication or dosage."
To say a bit more from an auditing perspective, there should be documentation supporting that the physician made a decision to continue the medication at the same dosage vs. reviewed a list of the patient's medications without evaluating the patient's current condition and making a decision on the appropriate management. Often this is found in the assessment and plan such as: diabetes type 2, improved A1c, continue Metformin as prescribed, refill ordered.
Cindy
Sorry this came out in all bold font. Not sure why.
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