# Medical Decision Making Requirements



## dyoungberg (Sep 22, 2014)

One of my providers asked me if they had to actually prescribe medications that they felt they were managing to be able to choose a moderate management option from the Risk Table in Medical Decision Making.  She used the example of patient's PCP prescribed cholesterol, hypertension and blood thinner medications.  Our provider reviewed the list with the patient during their visit and agreed the patient should remain on the medications as they related to the reason we were seeing the patient.  Does this qualify as Moderate Management Option on the risk table?

I say no because our provider did not prescribe the medication and therefore wouldn't be "managing it".

Any thoughts on this?

Debbie Y


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## BenCrocker (Sep 22, 2014)

I don't see anywhere in the CPT guidelines where medications are a deciding factor. But the medications were "reviewed" thus they become part of the MDM. Though this opinion is just an observation of the books guidelines I may have missed something.


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## mhstrauss (Sep 22, 2014)

dyoungberg said:


> One of my providers asked me if they had to actually prescribe medications that they felt they were managing to be able to choose a moderate management option from the Risk Table in Medical Decision Making.  She used the example of patient's PCP prescribed cholesterol, hypertension and blood thinner medications.  Our provider reviewed the list with the patient during their visit and agreed the patient should remain on the medications as they related to the reason we were seeing the patient.  Does this qualify as Moderate Management Option on the risk table?
> 
> I say no because our provider did not prescribe the medication and therefore wouldn't be "managing it".
> 
> ...




I love how docs can get so creative with things they think they should get credit for!! 
IMO ( I don't remember seeing this answer specifically in writing), No, provider should not get credit for this.  If that were the case, every doc who reviews a med list and says "Yea, that looks good", would get credit (with maybe the exception of a Consult, where the provider is being asked his opinion on managing a specific condition).  My thoughts are that if the provider did not write the original prescription, or isn't taking over prescribing the med, then, no, no credit in MDM. Just my $0.02!

HTH!!


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## Tonyj (Sep 22, 2014)

dyoungberg said:


> One of my providers asked me if they had to actually prescribe medications that they felt they were managing to be able to choose a moderate management option from the Risk Table in Medical Decision Making.  She used the example of patient's PCP prescribed cholesterol, hypertension and blood thinner medications.  Our provider reviewed the list with the patient during their visit and agreed the patient should remain on the medications as they related to the reason we were seeing the patient.  Does this qualify as Moderate Management Option on the risk table?
> 
> I say no because our provider did not prescribe the medication and therefore wouldn't be "managing it".
> 
> ...



What if the Rx given by the PCP is conflicting with the treatment your doctor is prescribing and your physician ordered the patient to cease taking the medication Rx'd by the PCP or recommends other meds or different doses? Would he/she not be managing the prescribed meds? 

What if there's no conflict in the treatment Rx'd by your physician and the meds your patient is taking Rx'd by the PCP and your physician agrees for the patient to continue said meds as prescribed? Would that not constitute Rx management?

I do understand what other coders are saying and I'm sure some physician may push the envelope at times but I'd give the benefit of the doubt and say yes they would deserve a moderate on the table of risks under management options.

Just my nickle.


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## BenCrocker (Sep 22, 2014)

Tonyj said:


> What if the Rx given by the PCP is conflicting with the treatment your doctor is prescribing and your physician ordered the patient to cease taking the medication Rx'd by the PCP or recommends other meds or different doses? Would he/she not be managing the prescribed meds?


 In this case I'd say they are managing the Rxs.


Tonyj said:


> What if there's no conflict in the treatment Rx'd by your physician and the meds your patient is taking Rx'd by the PCP and your physician agrees for the patient to continue said meds as prescribed? Would that not constitute Rx management?


 In this case we have our original question and I have no idea.


Tonyj said:


> I do understand what other coders are saying and I'm sure some physician may push the envelope at times but I'd give the benefit of the doubt and say yes they would deserve a moderate on the table of risks under management options.
> 
> Just my nickle.


And I agree.


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## LLovett (Sep 23, 2014)

Without even going into the Rx management issue, you are dealing with 2 or more stable chronic conditions. This by itself is moderate in the table of risk.

Remember, Rx drugs may be the "easy out" in a lot of cases but there are other options you can consider. 

Just my input for what its worth,

Laura, CPC, CPMA, CPC-I, CEMC


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## dyoungberg (Sep 25, 2014)

LLovett said:


> Without even going into the Rx management issue, you are dealing with 2 or more stable chronic conditions. This by itself is moderate in the table of risk.
> 
> Remember, Rx drugs may be the "easy out" in a lot of cases but there are other options you can consider.
> 
> ...


Thank you all so much for your input. You have given me food for thought and helped a great deal!

Debbie, CPC


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## senthilcpc (Sep 25, 2014)

*Rx Drug*

How about the below two Q & A taken from the mentioned web long time ago....( Now it shows path error)

It?s clear that we can consider it as Moderate risk if the physician decides to continue with Rx drug....



Q.8. What exactly is meant by prescription drug management in the table of risk? Do I have to add, stop or adjust a drug?

A.8. Prescription drug management in the risk table is very easily defined and described. It can be a simple monitoring or a prescription drug (any single drug), assessing the need for the continued use in the plan of care and assessing the need for a change in drug, dose or discontinuing it altogether. There does not need to be a change of any kind and long as the medical record reflects the fact that a prescription drug was considered for the plan of care of a patient. A list of medications alone would not satisfy the medical record reflecting that a prescription drug was assessed for use in the plan of care for that particular date of service. The record should state something like: "continue XYZ at the same dose for (diagnosis)". 
www.medicarenhic.com/ne_prov/seminars/FairSpring2009QandA.pdf

Q. During an evaluation and management visit, what constitutes ?prescription drug management??

A. ?Prescription drug management? is based on documented evidence that the provider has evaluated medications as part of a service, in relation to the patient. This may be a prescription being written or discontinued, or a decision to maintain a current medication/dosage.

Note: Simply listing current medications is not considered ?prescription drug management.?


http://medicare.fcso.com/FAQs/Answers/158639.asp


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## mhstrauss (Sep 26, 2014)

senthilcpc said:


> How about the below two Q & A taken from the mentioned web long time ago....( Now it shows path error)
> 
> It?s clear that we can consider it as Moderate risk if the physician decides to continue with Rx drug....
> 
> ...




I've seen this guidance numerous times, but I've always understood it to apply to the physician that was actually prescribing the med, not all providers that happen to see that patient and review their meds.  Just another one of those lovely gray areas!!


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## CatchTheWind (Sep 30, 2014)

It seems clear that as long as the provider is involved in reviewing and evaluating the medications - making a decision as to whether to continue or discontinue, increase, or decrease - this would constitute prescription management.


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