Internal Medicine Coding Alert

Question: The internist was going to prescribe Methotrexate and Remicade, which would require intensive monitoring for toxicity. She documented her reasons and her discussion with the patient concerning this treatment option. Then, after additional discussion and decision-making, the physician decided to use a different drug, which doesn't require intensive monitoring for toxicity. Can we still choose the high-management option from the Table of Risk based on the previous?

Vermont Subscriber

Answer: There is no set definition for the Table of Risk's intensive monitoring for toxicity option, according to coding experts. In many cases, the decision regarding which level of prescription drug management to select varies among practices, chart reviewers and payers. Yet, in your situation, your safest choice - especially to protect against denials or an audit - would be to document and bill for the moderate management option.
 
Reason: Your physician chose not to go with the higher-risk drug, so the monitoring of toxicity never occurred. Therefore, you cannot have a risk level for something your physician didn't do.