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medication management

  1. Question medication management
    Medical Coding Books
    I have a question that was raised during a coding audit regarding medication management. On an established patient who is on a prescription medication and is having the prescription refilled (either at the same dose or an increased/decreased dosage) is it considered a moderate or low risk level in medical decision making? There is some confusion regarding this. We always count new rx's as a moderate risk but refills at the office visit are a little gray. Any suggestions would be welcome. Thanks.

  2. #2
    If an established pt is seen and a new med is introduced, all aspects must be considered. Is the med Ibuprofen? Is that, really, a moderate risk? Is the med Coumadin? How does that risk compare to Ibuprofen? In any case, for a follow up, only 2 of the 3 criteria must be met or exceeded to choose a code (i.e. history, exam, MDM). If an established pt is there for a refill of the same dose, it seems to me the risk of complications or morbidity is low. A change in dose, however is different. But again, what is the med? I hope this helps. Isn't this business a blast?

  3. #3

    doesn't matter if they are changing the dose, doesn't matter what the drug is....doesn't matter the illness

    of course the rest of the note and medical necessity with dictate the code given.

  4. #4
    I am with Box of Rain on this one, it doesn't matter what drug it is as long as it is RX management...


  5. #5
    i agree, moderate.
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  6. #6

  7. #7
    Cactus Wren
    Moderate always

  8. #8
    Default RX Mgmt
    OTC drugs are low risk, prescription drugs are Moderate and IM or IV parenteral are Hi Risk ( Heperin, Ativan, Thrombolytics, etc)

  9. #9
    Quote Originally Posted by anne1607 View Post
    OTC drugs are low risk, prescription drugs are Moderate and IM or IV parenteral are Hi Risk ( Heperin, Ativan, Thrombolytics, etc)

    I agree that OTC drugs would be low risk also... I hope I didn't give the impression they would be moderate... I guess we do have to be "clear" when we are giving others advice... good catch Anne.

    Have a good one...
    Roxanne Thames CPC, CPC-I, CEMC

    "Remember the greatest gift is not found in the store but in the heart of true friends"

  10. #10
    just because you are adding/refilling or even changing a script does not mean it is going to be a moderate MDM. and i agree it doent matter what the script is unless it is OTC medicine.
    MDM you need 2 out of 3 components,
    # of presenting problems, amount of data/complexity(diagnostic procederures) and managment option. Just because a script is ordered will not always make a moderate MDM. this has been a misconception among our doctors too. and being through a medicare audit we got that straightened out in a hurry.

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