# ED MDM: prescription drug management



## modal (Jul 27, 2010)

Since we got our new EHR, now all our Emergency Physicians include H&P elements to meet 99284 or 99285.

So, into the obscure aspects of Medical Decision Making.

In the Table of Risk, management options, management options selected is the phrase
"prescription drug management".

Does this mean merely that the patient received a prescription at that ER visit?

Since many of our patients receive prescriptions, this would indicate a moderate complexity, when combined with the fact that most ER patients are new to the examiner = 2 moderate levels for an overall moderate MDM score.

This means alot of 99294 physician E/M levels.

Is my understanding correct?

How are others dealing with this H&P inflation that seems to accompany EHR?
Marcia


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## Networker3412 (Sep 17, 2010)

can someone answer this question? i would like to know this as well but i am not expert at e&m coding


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## sbicknell (Sep 18, 2010)

The 3rd section of the risk table is managment options. The physician basically gets credit based on how he decides to treat or manage the problem. Prescription drug management can include an IM injection, an IV infusion or as script to pick up on the way home.

So yes, for MDM a lot of ED encounters can audit out as Moderate MDM. Based on 3-4 points for new problem w/ or w/o workup and Mod risk (RX drug management ) the overall MDM will be moderate. If the physician has documented a Detailed History and a Detailed exam then you will end up with a 99284

But the high level of 99284s does not necessarily mean there is a problem. I worked with a group of specialists that I used to tell them not to worry about the # of high level E&Ms as they were seeing acute and complex patients not runny noses and rashes. The same with the a lot of the patients presenting to the ED


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