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Thread: Table of Risk

  1. #1

    Default Table of Risk

    I am looking for any articles or documention regarding the specifics for the table of risk, prescription drug management. It seems that there is a difference of opinion regarding what is considered "Prescription Drug Management". Some say if you write any script that it counts and others feel that you have to actually be managing a script for an illness. Looking for what other have found or interpret it.

  2. #2
    Join Date
    Apr 2007
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    Kansas City, MO
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    I don't have an article to site, but have read many times that simply "refilling" an rx for a stable disease shouldn't count, where as a new rx would. I tend to follow this. (remember you can meet the moderate risk with only having two or more stable chronic dz anyway)
    Unfortunately the documentation guidelines don't specify, so unless a carrier has specific instructions pertaining to this, its pretty much left open to interpretation.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3

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    I have been told that if you can get the medication over the counter, ie: without a script, even if the doctor writes one, then it doesn't count. Also, the last poster said something about not counting refilling a prescription for a stable condition, however it has been argured to me that refilling a prescription still carries an inherent risk because you have to judge if anything has changed that would make the medication act differently.

  4. #4

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    If a patient comes in for a refill of a medication for one chronic problem, I would assign this as low risk. If you reference the presenting problem(s) on the table of risk, one stable chronic illness equates to a low risk. If the patient presented for multiple refills, again referencing the presenting problem(s) on the table of risk, this would equate to moderate risk because of two or more stable chronic illnesses. Again the risk is only one part of the overall MDM.

    Just my two cents for whatever it is worth.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  5. #5
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    Milwaukee WI
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    Default Table of Risk

    The table of risk is an attempt to quantify the risk TO THE PATIENT of the presenting problem(s) and/or recommended treatment.

    Prescription drugs pose the same risk to the patient whether it is a new prescription for a new problem or a refill of an existing medication for a chronic problem. (Although I DO agree with Juanita - if you are giving the patient a Rx of a readily available OTC drug, I'd be inclined to NOT count this as moderate risk.)

    Whichever box on the table of risk has the "highest" level of risk is the risk for that encounter.

    So even if you have only one stable chronic illness (e.g. diabetes), if you are getting a refill of your Rx for insulin you have moderate risk.

    Now, whether that will translate to moderate MDM will depend on whether you have at least 3 problem points or 3 data points, in addition to moderate risk.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6

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    I resepectfully disagree. Refill of a medication for one stable chronic illness is low risk not moderate. Again reference the presenting problem.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  7. #7

    Default

    Quote Originally Posted by FTessaBartels View Post
    The table of risk is an attempt to quantify the risk TO THE PATIENT of the presenting problem(s) and/or recommended treatment.

    Prescription drugs pose the same risk to the patient whether it is a new prescription for a new problem or a refill of an existing medication for a chronic problem. (Although I DO agree with Juanita - if you are giving the patient a Rx of a readily available OTC drug, I'd be inclined to NOT count this as moderate risk.)

    Whichever box on the table of risk has the "highest" level of risk is the risk for that encounter.

    So even if you have only one stable chronic illness (e.g. diabetes), if you are getting a refill of your Rx for insulin you have moderate risk.

    Now, whether that will translate to moderate MDM will depend on whether you have at least 3 problem points or 3 data points, in addition to moderate risk.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Agree. Even "CPM" (Continue Present Meds) carries a risk and is "moderate" (assuming these are prescription meds).

  8. #8
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    HUNTINGTON, WV
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    I also agree. The patient is still at risk with any prescription medication regardless if it's new for the patient or not. I always code to Moderate risk even if the just continue a current medication.
    JENNIFER WESTFALL, RHIT, CPC, CGSC

  9. #9

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    Prescription drug management has always been defined to me as either starting, stopping, or changing the patient's meds. If the patient presents for a refill of a med for a stable problem, you are not starting, stopping, or changing the meds. You are just refilling it. You already know how they are going to respond to the meds; otherwise you would not be refilling it! A stable chronic problem would net low risk. Reference the Table of Risk and look at the Presenting Problem.

    If you were refilling multiple meds, then I agree this would be moderate risk.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  10. #10
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    The Risk table is the most difficult piece of the Medical Decision Making section to understand. The column " Management Options Selected" has examples of "management markers" for each level of risk which correlate with the same levels of risk in the other two columns. For management of a chronic stable medical problem with prescription drug(s) the choice of moderate is not based on the idea that drugs are dangerous or risky but rather that the idea that a chronic problem that requires a prescription drug for management is an inherent increased medical risk for the patient.
    The same is true for the surgical risks in the same column. The risk level is not attained primarily because the patient may die from the surgery but rather that the primary condition requiring the surgery is the risk driver.
    I am sorry if I sound pedantic. I practiced for 16 years and have spent 6 years educating myself and other practitioners about E&M Coding. It is a tough area and I still learn.
    AKW MD CPC

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