Results 1 to 5 of 5

Medical Decision Making question - spending plan

  1. #1
    Location
    Ellenville, New York
    Posts
    1,176
    Default Medical Decision Making question - spending plan
    Medical Coding Books
    Fellow auditor and I had this discusssion on a chart I am auditing - who's right?

    For abd pain, doctor prescribed ibuprofen and wrote patient a script because she needed it to use her flex spending plan for the medication. Because he wrote a script, my co-worker believes this is prescription drug management resulting in a moderate level of MDM. I say this is low level because ibuprofen is available OTC. Whatever the result of this will determine the MDM for this particular chart because the data is limited and the number of diagnoses is multiple.

    Thanks for your help in advance!

  2. #2
    Default
    Writing a prescription does not determine medical decision making. You need to go with the medical necessity of the visit. Use only the Presenting problem column on your level of risk table. If your presenting problem is low level of risk then it is low.
    Kim Reynolds, CPC

  3. Default
    Quote Originally Posted by MnTwins29 View Post
    Fellow auditor and I had this discusssion on a chart I am auditing - who's right?

    For abd pain, doctor prescribed ibuprofen and wrote patient a script because she needed it to use her flex spending plan for the medication. Because he wrote a script, my co-worker believes this is prescription drug management resulting in a moderate level of MDM. I say this is low level because ibuprofen is available OTC. Whatever the result of this will determine the MDM for this particular chart because the data is limited and the number of diagnoses is multiple.

    Thanks for your help in advance!
    If he prescribed 800 mg then that is considered a script. If not, then it is just an OTC med and not prescription drug management. Hope this helps

  4. #4
    Default
    Always keep in mind the medical decision making must also be in line with the nature of the presenting problem. Just because a script is given does not always = moderate MDM.

  5. #5
    Location
    Ellenville, New York
    Posts
    1,176
    Smile Thanks!
    Thank you for the feedback. Complaint was severe abd pain, pt was following up from CT scan that was "unremarkable" - therefore we felt this would "acute uncomplicated illness or injury (nature of presenting problem). Script for for Ibuprofen 400 mg, so that did not meet that 800 mg threshold. The nature was why I wanted to go low MDM, co-worker felt the need to prescribe was reason for moderate. Thanks for all the input. Sounds like I should do a victory dance!

Similar Threads

  1. Medical Decision Making Question
    By Svirgilio in forum E/M
    Replies: 2
    Last Post: 08-14-2013, 07:08 AM
  2. Medical Decision Making question
    By ttate in forum E/M
    Replies: 0
    Last Post: 12-01-2010, 01:14 PM
  3. Replies: 9
    Last Post: 05-08-2009, 02:14 PM
  4. Medical Decision Making Question
    By mlillard in forum E/M
    Replies: 2
    Last Post: 02-29-2008, 11:07 AM

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?

Login

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.