# High Risk Medications



## kathymoon (May 14, 2014)

I have at least one provider that insists that prescribing narcotics, or other high risk medications, is a reason for a High Risk visit. (99215).  Can someone tell me if there is further documentation to support this?  So far, I am finding nothing because these are not necessarily being monitored for toxicity.  I have one patient who he prescribes Oxycodone, Diazepam and Kadian.  He states each of these is high risk medication "as there is increased potential for adverse reaction  in some groups."  I need to meet with this doctor, next week and I would like to be well informed and well prepared.  

If you know of any specific guidelines or articles, plesae share.  Thanks.


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## MnTwins29 (May 14, 2014)

If you are thinking of the high risk by monitoring toxicity with the example givien on E/M audit tools, keep in mind that those examples are not the be all end all.   I actually agree with your doctor that there is additional risk to these medications compared to non-controlled substances.

That said, I would be more concerned that he believes that just because he prescribes a "high-risk" drug that means the encounter is automatically 99215.  Since risk is only one of three aspects of MDM, which is only one of three key elements in the code, that is a stretch to say that just because the patient takes say oxycodone that it automatically is 99215.  Maybe that is what you need to educate him on - risk and drug management only applies to part of the MDM and that is only part of the code assignment.   The other elements have to match, not to mention you may need to prove medical necessity.   Good luck!


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## kathymoon (May 14, 2014)

So Lance,

This particular patient has several chronic issues for which she is being treated.  I can count at least three for this visit.  Cervical radiculitis, HTN (Controlled) and Anxiety (Stable).  Other diagnoses he's listed are Cervical Osteophyte and Cervico-Occipital neuralgia.  But I'm not sure they are not all somewhat related to the radiculopathy.  Anyway, with the three I can count and the narcotics, and a comprehensive history, do you think this would substantiate a 99215.  

Just looking for your opinion.  It's good to be able to bounce things off someone else before meeting with the "almighty doctor."

Thanks for your input.


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## MarcusM (May 14, 2014)

If a condition like radiculitis is "controlled and stable" without an acute flare up of radicular type pain that is clearly affecting activities of daily living, then I think it would be hard to justify a level 5 visit.  Yes, in this case, there are co-morbidities but he is not treating all of her conditions, is he?  Each visit must have the necessary documentation for that visit to support a level 5.


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## MnTwins29 (May 15, 2014)

In addition to Marcus's observations which should be addressed, you mentioned a comprehensive history - what about the exam as well?  Does he examine at least 8 body systems if you use 1995 or meet the 1997 guidelines for whatever his specialty is?    Just making sure that ALL bases are covered before automatically giving the visit a level 5.

I had to provide education on something like this to a cardiologist - she believed the more diagaoses she listed the higher the level.  When she came on board to our practice, I took a sample of her office visits the prior month - every single one of them was 99215 based on reasoning much like your physician.  YIKES!  Glad she was receptive to my education and since joining us, the coding has been MUCH better.


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## kathymoon (May 15, 2014)

I thank both of you for your input.  And I agree completely.  Just wanted to make sure I am prepared for this particular meeting.  And Lance, I have several docs that seem to think the same thing.  They figure if they list the entire history of chronic issues it'll be a level 5.  I've been working on that one and still am.  

Again, thanks for the back-up.


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