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March 25, 2023

Prescription drug management and medical decision making (MDM)

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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.

 

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Last revised December 19, 2022 - Betsy Nicoletti
Tags: level of service_MDM

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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