Results 1 to 3 of 3

Moderate MDM with prescriptions ???

  1. Default Moderate MDM with prescriptions ???
    Medical Coding Books
    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
    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. Default
    Yes, that certainly did help.

    Thanks so much !

Similar Threads

  1. Moderate Complexity or High Complexity MDM
    By kathymoon in forum Auditing General Discussion
    Replies: 9
    Last Post: 06-23-2014, 08:19 AM
  2. MDM Moderate if DC all medications?
    By sjsantjer in forum E/M
    Replies: 3
    Last Post: 10-20-2011, 07:53 AM
  3. Moderate MDM
    By sauls in forum E/M
    Replies: 3
    Last Post: 12-20-2010, 01:24 PM
  4. Moderate vs. High Severity MDM?
    By 1071471 in forum E/M
    Replies: 6
    Last Post: 03-30-2009, 04:29 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.