AAPC - Back to school
Results 1 to 6 of 6

Thread: Prescription Drug Management

  1. #1

    Question Prescription Drug Management

    AAPC: Back to School
    Hi all,

    Can anyone tell me where I can find documentation for Medicare, the AMA or other reliable source that will tell me (in the table of risk) how much value is given to prescrition drug management.

    A patient that comes in the an urgent care and given a prescription. In the table of risk the prescription is listed a moderate level of risk, however if the nature of the presenting problen and final diagnosis may be a low level of risk.

    This is difficult to explain this way, but I'm hoping one of you can help.

    I need to find clear documentation (if at all possible) for educational puposes.

    Can anyone help?

    Thank you!!

  2. #2


    I found this information on the CMS website:


    It is on the evaluation and management download. On the risk factor sheet.

    I hope it helps.


  3. #3


    Thank you, Dawn.

    That is good general information but I'm looking for something specific regarding the risk table and prescription drug managment. There seems to be two philosophies regarding prescription drugs and the table of risk. Some auditors view prescription drug as a moderate level of risk as it is listed in the table of risk, while others downcode if the chief complant is of low risk even though a prescription may have been given. I have been unable to locate a reliable source addressing this issue and hope that someone can provide documentation on this issue from a reliable source.

    Thank you.

  4. #4

    Default PRescription Drug Mgmnt


    I'm having the same problem..I know that all the audit tools direct drug management to "moderate" but if the #of diagnosis, and data reviewed are minimal then the MDM cannot be moderate. My superior who is an R.N. does not agree with the "moderate" theory for all RX management either and has asked me to get more insight too...


  5. #5



    I hope this helps. This is the information from the 1995 rules.

    The following table may be used to help determine whether the risk of significant complications,
    morbidity, and/or mortality is minimal, low, moderate, or high. Because the determination of
    risk is complex and not readily quantifiable, the table includes common clinical examples rather
    than absolute measures of risk. The assessment of risk of the presenting problem(s) is based on
    the risk related to the disease process anticipated between the present encounter and the next one.
    The assessment of risk of selecting diagnostic procedures and management options is based on
    the risk during and immediately following any procedures or treatment. The highest level of risk
    in any one category (presenting problem(s), diagnostic procedure(s), or management options)
    determines the overall risk

    Having a prescription alone does not raise the EM level it just raises the risk level to moderate.

    good luck,

    PS this information is found on page 13 of the cms 1995 link given above.

  6. #6
    Join Date
    Apr 2007
    Garden State Chapter, Cherry Hill, NJ


    I agree that simply prescribing a medication does not make the MDM moderate. You must incorporate either the DMO or the Data from the MDM section. For example, a patient has stable HTN, labs are ordered and an Rx for an ACE inhibitor is given. DMO = 1 pt, Data = 1 pt and Risk = moderate. In this example, the level of MDM is Straightforward...
    This information can be found in both the 1995 and 1997 CMS Evaluation and Management guidelines.
    Hope this helps!

    Colleen A. Wade, CPC, CPC-H, CPC-E/M, CPC-I, PCS, FCS
    Owner, Coding Healthcare Education and Consulting
    "CHEC your educaiton needs with me!"

Similar Threads

  1. Prescription Drug Management
    By TEDWAR08 in forum Auditing General Discussion
    Replies: 1
    Last Post: 06-30-2014, 07:15 PM
  2. Prescription Drug Management
    By skaur in forum E/M
    Replies: 3
    Last Post: 01-04-2013, 10:54 AM
  3. Prescription Drug Management
    By cpclori in forum Auditing General Discussion
    Replies: 3
    Last Post: 08-18-2012, 09:02 AM
  4. Prescription Drug Management
    By clarkin in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 09-28-2011, 05:29 PM
  5. Prescription Drug Management E/M ?
    By renakirk in forum E/M
    Replies: 5
    Last Post: 01-28-2010, 03:02 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.