# MDM question



## khaspert (Mar 7, 2008)

Does anyone out there have any experience with using drugs that need intensive monitoring to support a high level of risk in the risk portion of MDM.  For example, coumadin is a drug that my physicians have identified as one that needs intensive monitoring.  Would you always choose "high risk" in the MDM when a patient comes in who is on coumadin and the your physician is the one monitoring it?

Kim


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## yvette31 (Mar 8, 2008)

I would think this would be Moderate "Prescription drug management"

yvette


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## codegirl0422 (Mar 8, 2008)

I agree with yvette31. The drug itself needs intensive monitoring and may be considered a "high risk".  But the medical decision making itself is not high risk. 

Under intensive monitoring it mentions toxicity. Guidelines under MDM for E/M levels:
DG: High risk of MDM: "Drug therapy requiring intensive monitoring for toxicity"

My understanding of Coumadin is:
The objective of treatment with a blood-thinner is to control the blood-clotting process without causing severe bleeding, so that a clot does not form and cut off the blood supply necessary for normal body function. Therefore, it is very important that you take Coumadin exactly as prescribed by your doctor and that your doctor monitor your condition on a regular basis. 

My question is, is there a toxicity risk? I see the need to monitor but don't see the toxicity risk. I could be looking at wrong but the definition of toxicity is 1.  the degree to which something is poisonous  & 2.  grave harmfulness or deadliness .

Hope this helps. I used to code for pain management where there were drugs prescribed that were high risk (prescriptions and medication for pain pumps) and we never used high risk for MDM. The way it was described to me is the way I stated it at the top, the drug is High Risk, but the MDM is not.




khaspert said:


> Does anyone out there have any experience with using drugs that need intensive monitoring to support a high level of risk in the risk portion of MDM.  For example, coumadin is a drug that my physicians have identified as one that needs intensive monitoring.  Would you always choose "high risk" in the MDM when a patient comes in who is on coumadin and the your physician is the one monitoring it?
> 
> Kim


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