Prescription Drug Management and Medical Decision Making (MDM)

Whether selecting a level of service for an E/M encounter, the question arises about what counts as prescription drug management. In both sets of guidelines, it appears in the moderate medical decision making (MDM) row.

The question arises, should we credit prescription drug management for new prescriptions, medication adjustments, and renewals? My answer has always been yes. Neither the original guidelines or the new guidelines say that a new prescription or change is needed in order to credit prescription drug management. At least one national payer, Anthem, has edited the original table or risk to indicate that renewal is low MDM and a new or changed prescription is moderate.

Again, I completely disagree with that. There is no CPT or CMS citation to support it.

Documentation Guidelines

Remember what Dr. McCoy says, “The bureaucratic mindset is the only constant in the universe.”

While we are using these complex guidelines, let’s not add to bureaucratic mindset by developing our own guidelines. Use the ones CMS and the AMA developed.