Ob-Gyn Coding Alert

Question: What qualifies as prescription drug management, which is a moderate-risk level in the complications and/or morbidity or mortality of patient management element of medical decision making (MDM)? Do patients who are continuing their treatment with no changes of meds or dosage qualify toward this level of MDM?

Maine Subscriber

Answer: CPT^® currently has no guidelines for this. However, you can get a sense of how MDM for this element plays out by looking to Medicare’s directions for prescription drug management.

According to Novitas Solutions, a Part A/B Medicare Administrative Contractor (MAC), you can get MDM credit for prescription drug management “when documentation indicates medical management of the prescription drug by the physician who is rendering the service. Medical management includes a new drug being prescribed, a change to an existing prescription or simply refilling a current medication. The drug and dosage should be documented as well as the drug management” (Source: www.novitas-solutions.com/webcenter/ portal/ MedicareJL/pagebyid?contentId=00005056).

This indicates you should note the drug and the amount prescribed along with a note showing your provider has decided to either change or not to change the prescription drug during the encounter. Simply put, without documenting these three things, you will not be able to justify a moderate level of MDM for prescription drug management. But remember that prescription drug management alone will not mean you have met the criteria for moderate MDM. The documentation must also support a moderate level of either the number and complexity of problems addressed at the visit and/or the amount and/or complexity of data reviewed and analyzed.