Cardiology Coding Alert

Question: According to the medical decision-making (MDM) section of an E/M visit and the table of risk, prescription drug management is "moderate complexity," and drug therapy requiring intensive monitoring for toxicity is "high complexity." Given that, where do Coumadin and Amiodarone management fall -- moderate or complex?

Ohio Subscriber

Answer: Amiodarone is probably one of the best cardiology-specific examples of drug therapy that requires intensive monitoring for toxicity. You should consider it a high-complexity drug. Coumadin is a drug that modifies the patient's blood-clotting capabilities.

Physicians frequently perform Protime studies to measure the patient's Coumadin level. But physicians use this frequent monitoring to gauge the appropriate dose and to keep the Coumadin levels in a therapeutic range. Coumadin monitoring is different from monitoring for toxicity, so you should consider Coumadin a moderate-complexity drug, as far as the table of risk is concerned. 
 
You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.