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medication management

  1. #11
    Default MDM vs. Moderate in table of risk
    Medical Coding Books
    MDM vs. Moderate in table of risk
    you are absolutely correct that an rx does not make MDM moderate complexity. However; in the table of risk (C)on most audit tools, it does carry a moderate risk

  2. #12
    Default
    Interestingly enough, on E/M's University case of the week, Dr. Jensen has this same scenario. See below.

    CC: Dyslipidemia

    INTERVAL HISTORY: The patient is here to discuss risks and benefits of statin medication which was started last time for dyslipidemia with LDL of 160. Several friends have had adverse reactions to these agents and she wants to know if she really needs to continue this medication.

    PHYSICAL EXAM
    NAD, conversant; looks younger than stated age.
    BP 124/72 HR 84 RR 18
    Lungs: CTA
    CV: RRR
    EXT: No peripheral edema

    Labs: LDL 92

    IMPRESSION
    1. Optimally controlled dyslipidemia

    PLAN
    1. Continue PRAVASTATIN 10 mg PO QD.
    2. RTC in six months with LFTs and lipid panel.

    Time: I spent 16 minutes face-to-face with the patient, over half of which was devoted to counseling and/or coordination of care. We discussed the role of statin medications in primary prevention of cardiovascular events. All questions were answered to her satisfaction.


    For MDM, here is what he did:

    Here you get only one problem point for the established and stable problem of dyslipidemia.

    Here you get one data point for ordering and/or reviewing labs.

    This encounter qualifies as being of low risk based on the presence of one stable chronic illness.


    One reader was wondering why the risk was low instead of moderate based on the RX. Dr. Jensen says that in order to qualify for moderate risk for RX management, you should be starting, stopping, or adjusting the medication.

    I agree with Dr. Jensen on this. The "risk" is the "risk until the next encounter" if the medication has proven to work and control the issue from the initial encounter to present encounter, if nothing has changed in the patients condition to warrant a change in the med(s), the "moderate risk- RX management" should not be used.

  3. #13
    Location
    Woodland Hills, CA
    Posts
    121
    Default
    Refill of an Rx drug is still considered presciption management.
    So, I would count as Moderate risk. It does not neccesarily mean that the overall MDM would be moderate, but the risk would be for sure.
    Last edited by HCCCoder; 08-25-2008 at 07:37 AM.
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  4. Default
    I disagree w/ an Rx refill always being moderate. You don't necessary to have to have an exam to get an Rx refill, you can call in, so why is it worth a moderate risk. Changing an Rx may require a reaction (positive or negative) to the drug, possible labs or testing, and discussing how to take the meds appropriately and the possible side effects and so-forth. A refill requires the Dr. to write out an RX. If there isn't anything wrong, there isn't anything to really manage. I think this is based on interruption of the rule. I say Low Risk....unless something changes.
    adrianne, cpc

  5. #15
    Default
    I have been told that if you are prescibing a patient a prescription dose of an OTC (600 mg or greater) then it can be counted as moderate risk. I have also been told that any prescription given can count as moderate risk as well. Interesting points of view on this thread, makes me think about it in a different light. I was thinking that they put into a moderate risk catergory because of the doctor assuming a higher level of risk because that would require many different aspects to be considered before prescribing the med to the patient. Just my thoughts...

  6. #16
    Location
    Woodland Hills, CA
    Posts
    121
    Default
    Quote Originally Posted by abenson View Post
    I disagree w/ an Rx refill always being moderate. You don't necessary to have to have an exam to get an Rx refill, you can call in, so why is it worth a moderate risk. Changing an Rx may require a reaction (positive or negative) to the drug, possible labs or testing, and discussing how to take the meds appropriately and the possible side effects and so-forth. A refill requires the Dr. to write out an RX. If there isn't anything wrong, there isn't anything to really manage. I think this is based on interruption of the rule. I say Low Risk....unless something changes.
    I am NOT talking about exam. I am just talking about the RISK. And, again, like I said before, the RISK is going to be Moderate, not necessarily the level of service. In your case, if the doctor is not going to exam the pt, then the PE would be PF(or none, based on documentation) and # of diagnoses option would be 1 points (if there is 1 est. stable problem) and the risk would be moderate, because it is what it is, it is an Rx drug management. Whether you refill or adjust the medication, it is still counts towards moderate risk. How can you say "if there isn't anything wrong?". Obviously, there is, since pt is on the same medication for long time and is being treated for a chronic condition. This is what I learned from school, meetings, conventions and from my 5 years of experience.
    This is my opinion!
    Lilit
    Last edited by HCCCoder; 08-25-2008 at 07:54 AM.
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  7. #17
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    morning, I agree with most and with lmartirosyan most of all.
    based on the original question - I'd agree - prescription med management fulls under the "MODERATE" Management Options Selected area in the Complication Risk Factor(s) table. It is what it is....and it's always Moderate.
    I won't comment on MDM level because I can see that wasn't your question You weren't questioning your Number of Dx's or Amount of Complexity, or even your HPI or EXAM components. I'm sure you know how to determine the MDM based on the three. and your E/M level based on HPI/EXAM/MDM...
    so, back to your original question:
    Prescription medication management, it is what it is and it states it VERY clearly on the Risk Factor Table - it's "MODERATE".
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

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