Practice Management Alert

Question: The office where I work hands out free samples of prescription cream for skin conditions to some patients, usually with instructions to “use until gone.” One of my colleagues thinks that we should include this on visits as a level-four service under evaluation and management (E/M) for prescription drug management. I think that’s crazy, because even though the cream can be prescribed, it isn’t in this case. Who’s right?

New Mexico Subscriber

Answer: You are in the right; this situation should not qualify as a level-four service or prescription drug management.

If your provider is giving out the skin cream as a free sample, then it’s not actually prescribed.

Think about the word “manage,” says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

“Management” implies that the interaction with the patient and the prescribed drug is an ongoing process of evaluating the patient’s reception to the drug, looking out for toxicity, interactions, or side effects, she says.

In terms of E/M guidelines, prescription drug management can be: writing a new prescription, reviewing or changing prescribed medications or dosages, discontinuing an existing prescription and why, or a decision not to add new medications to the current drug regimen due to potential harmful side effects or interactions, Fletcher explains.

In this case, since the prescription skin cream is not actually prescribed to the patient, and there are no instructions specific to that patient’s use or any mention of a follow-up to check on the status of usage, the encounter does not qualify as level-four service.