# 'Intensive Drug Monitoring' on Risk Table



## AmandaW

Hey all, 

 I'm trying to get a clear definition of 'Drug therapy requiring INTENSIVE MONITORING' to toxicity on the Risk Table. 
 Google has confused me further. 
 I'm trying to decipher when it would be in that category verses 'prescription drug management' in the moderate. 


 An example I have that one of my Drs brought up to me is a drug called Noctiva which treats Nocturia. 
 One of the main side effects is hyponatremia which CAN be life-threatening. So he will need to closely monitor the patients sodium levels. 

 But my question is what exactly is 'intensive monitoring for toxicity'. The internet definitely points me to when the patient is in the hospital and getting IV medications of controlled substances and such that might need to be titrated, but does this also apply to clinically monitoring? I think I read that this drug recommends checking sodium levels bi monthly or monthly. 

 I see that Gentamicin is on a list of requiring intensive monitoring for toxicity. We give this often for UTI's. So, if the patient has a UTI and we give them this injection (I know I still need 2 out of 3 in MDM), but I can put it in the high spot on the risk table??


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## Pathos

Check the patient's insurance carrier policy. I've seen a couple MAC policies regarding this subject which might be helpful.

I often refer to an article published in AMA (can't find the link now though) by Pam Brooks, CPC. 

While plenty of drugs can be considered "High Risk Drugs" due to the nature of the drug, the "Intensive Drug Monitoring" is only applied when a standing order for lab tests are included. Pam has the following example:" Although subcutaneous insulin is considered a high-risk medication per most hospital and clinic policies, unless the physician orders weekly or bi-weekly serum blood tests to monitor the efficacy of the insulin, this does not meet the definition of high-risk management. A newly diagnosed T1DM child might meet this level of management, but a long-term well-managed diabetic may not.

Pam also mentions Coumadin as a very high risk drug, but states that taking the drug alone is not enough to consider high-risk monitoring. Still need the actual labs or something which proves the provider is following the studies very closely, as there is a real risk for health deterioration.

We also have our providers add Z79.899 Other long term (current) drug therapy, to show the insensitivity of the drug monitoring, along with a recurrent lab order. No lab + drug, no Intensive Drug Monitoring in my book.

Sounds like the examples you are providing *could* be considered High Risk Drug Monitoring, however exact documentation is even more critical when the guidelines are a tad unclear.

Hope this is helpful!

Here are some links:

Palmetto High Risk Drugs (might be able to use towards the High Risk)

Old AAPC thread on the exact same topic


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## jbassett1

Here's some links to Palmetto that has helped us.
https://www.palmettogba.com/Palmett...tensive Monitoring for Toxicity?open&Expand=1


On below link if you scroll down to the tips from Feb 8th Palmetto has several links around toxic monitoring.
https://www.palmettogba.com/palmett...roviders~JM Part B~EM Help Center~Weekly Tips


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