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Thread: Moderate MDM with prescriptions ???

  1. #1

    Default Moderate MDM with prescriptions ???

    AAPC: Back to School
    Hello All,

    I am perplexed with reviewing some notes. If a patient has two or more stable chronic illnesses or a undiagnosed new problem and then gets a prescription, I would consider this moderate following the the medical decision making table. However; I have also heard that a new problem with a prescription does not have to substantiate a moderate level. I have also had different opinions in the event of prescription refills. Because it is a refill would that then be considered low? Again I have heard many different opinions on this. Any input would be great.



  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Table of Risk

    For the Table of Risk ... a box ANYWHERE in the table defines the level of risk.. Note this is not the same as the level of MDM; it is only one element of MDM.

    So if you have a patient with allergic rhinitis (acute, uncomplicated illness - low risk), for which you write a prescription for Zyrtec (Prescription drug managment - moderate risk), you would have moderate risk.

    Whether you have moderate MDM depends on how many problem points or how many data points you also have.

    If the allergic rhinitis is a brand new problem, you have at least 3 problem points, so you have moderate MDM.

    If it is an ESTABLISHED problem ... even if it is worsening ... then at most you have 2 problem points. Unless you have at least 3 data points, the most you will get is low-level MDM.

    Hope that helps

    F Tessa Bartels, CPC, CEMC

  3. #3


    Yes, that certainly did help.

    Thanks so much !

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