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Question: When is an evaluation and management service of medication justified?

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Answer: “Management” is the key word when trying to figure out if an E/M service for prescription drug management can be justified.

The pertinent guidelines were designed to give credit for work being performed, said Jaci Kipreos, CPC, COC, CDEO, CPMA, CRC, CPC-I, CEMC, in an AAPC HEALTHCON Regional panel on E/M services.

A common-sense place to start: Was the medication in question prescribed by the same provider who is trying to justify an E/M service for prescription drug management? What is the name of the drug and the dosage prescribed? For example, a patient may be prescribed several drugs by several providers, and a cardiologist looking over the dosage of an atrial fibrillation medication probably isn’t also involved in that same patient’s diabetes medication. 

It’s important to see and show that the provider is managing a treatment plan, such as by adjusting a dose, Kipreos said.

“It’s not that the patient just happens to be taking a medication. It’s the provider’s work in evaluating: Is that still the right medication? Are they suffering from any side effects from that medication? Are there any interactions with that medication and a new medication they might be considering …. It’s the thought process that the provider’s going through to determine the treatment plan to understand what’s going to be the best outcome for the patient, and then monitoring them on that treatment plan and making sure that there are no side effects from it,” she explained.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC