# Table of Risk/Medications



## mmunoz21 (Jan 13, 2009)

I have a Pain Management Doc, does the new pt consult, pt agrees on the trigger point injection during the consult, the Cr. Trigger point injection consist of a "Steroid and Lidocaine"....  Comprehensive history, Comprehensive Exam.
Would this be considered under prescription drug management "Moderate"???
Or since he did not prescribe anything, does the Dr. gets paid for the procedure of 'trigger point injection" with a low under risk and complications table?

Thanks


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## meganpoelzer (Jan 13, 2009)

That's a tough question. Personally, I don't think a trigger point injection would be considered "prescription drug management" because he's not  managing a prescription. I would think you should look at the presenting problem to determine risk of complications. 

I guess it could go either way though, should be interesting to see what other responses you get.

Megan Barber, CPC


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## cdcpc (Jan 13, 2009)

*Minor surgery w/ identified risk factors*

What about classifying this as a minor surgery with identified risk factors?  If the physician documented the trigger point injection and documented risk factors discussed with the patient, then you can count this as a moderate risk.  
I also agree with the above comment on the injection medication...it's not exactly prescription drug management.
I hope this helps!


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## RebeccaWoodward* (Jan 13, 2009)

I thought of that too...but "minor" to me equates with 10 day or so global period.  20610 has zero. I'm still undecided.


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## dmaec (Jan 13, 2009)

well, I'm wondering where the other two components of the consult fall and whether or not the MDM would be such an issue depending on that info; 
in other words if the HISTORY and EXAM meet Comprehensive - then in order to get a high level E/M 99244 - you'd need the MODERATE MDM - however, if your HISTORY and EXAM are DETAILED or EXPANDED PROBLEM FOCUSED - then the struggle with the MDM is over, because it certainly meets a "LOW or STRIAGHT FORWARD" MDM in my opinion - (actually I'd probably place it under the MODERATE considering the injection of drug for the trigger point pain/issue). if it does meet MOD - but the HISTORY and EXAM are DETAILED, it still gets dropped down to the LOW in order for the three of three elements to meet up ... (99243)
that being said, in my experience of such cases - it typically ends up to be a problem focused or expanded problem focused consult, because the patient is usually there for a specific reason.  If procedures are done (typically again, some sort of pain injection)... documentation supports a low level consult with  a .25 modifier on the E/M and the procedure code being billed out.


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## mmunoz21 (Jan 14, 2009)

*Table of Risks*

The Exam and History=Comprehensive

Thank you for all your responses...

It is a "Moderate Risk" considering that it is an chronic problem exarcebating..At first I was not considering this because the tabel of risks reads "chronic illness" vs "chronic problem" and I was not looking at "Back Pain" as an illness, but I have been assured by a couple of coders and speakers who deal with E/M that back pain is not an illness - but it can be an incapacitating life-altering condition. If you get pedantic on the terms - you've lost the handle on the use of the tables. 

Again Thanks!


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