Revenue Cycle Insider

Question: One of our clinicians administered a cortisone injection for a patient during an encounter. Can this count toward prescription drug management and thus nudge an encounter toward a higher level for evaluation and management (E/M) service?

Alabama Subscriber

Answer: According to the Medicare Administrative Contractor (MAC) Noridian, ordering an injection for a patient doesn’t count as prescription drug management. Further, injections for conditions like allergies or joint issues might not contribute to risk.

Noridian says: “Ordering an injection for the patient is not prescription drug management. There can be many different reasons for ordering injections including, but not limited to, birth control, cancer treatments, joint issues, allergies, and antibiotics. … ‘For the purposes of [medical decision making] MDM, level of risk is based on consequences of the problem(s) addressed at the encounter when appropriately treated. Risk also includes MDM related to the need to initiate or forego further testing, treatment, and/or hospitalization. The risk of patient management criteria applies to the patient management decisions made by the reporting physician or other qualified health care professional as part of the reported encounter.’ Choose the level of risk based on the physician or other qualified health care professional’s determination and documentation of the risk to that specific patient for that specific encounter for that specific treatment choice. Documentation in the medical record must support the decision for the treatment to bill for the administration of the injection and drug.”

It may be helpful to think about how administering an injection in the office doesn’t involve discussing with the patient the appropriate means of managing the injection, like how to store or administer it.

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