Pediatric Coding Alert

You might not be giving your pediatrician enough credit if you limit prescription drug management to prescription writing.

These management option answers will help you avoid this auditing pitfall and others.

The table of risk in the AMA-approved 1995 E/M guidelines lists prescription drug management as a common clinical example of moderate risk. "The provider has to evaluate the suitability of the patient for the medication and weigh the benefits and risks," explains Debra Pierce, MD, MBA, CPC, with Pierce Consulting in Rockbridge, Ohio.

Giving samples with or without a prescription all falls under prescription drug management. "The process of prescription drug management would include giving the patient the actual meds as samples, the thought process and risk would remain the same as writing it down on a piece of paper," says Nancy L. Reading RN, BS, CPC, CPC-I, nurse auditor and chief executive auditor for CedarEdge Medical LLC in Draper, Utah.

Example: A patient has allergic rhinitis. The pediatrician gives her samples of Astelin to try as needed. He tells her to call in for a prescription if she feels the prescription helps. This case constitutes prescription management.

You'll be at a lower level of risk if the encounter involves only over the counter (OTC) meds. "Risk assessment relates to the disease process anticipated between the present encounter and the next one," Pierce explains.

If the patient had not been given prescription samples or had merely been instructed to use over-the-counter drugs, there would be less risk involved. The table of risk provides OTC drug management as an example of low risk.