Wiki E/M & Monitoring Rx

[A622220]

Question~
Would you allow a provider to use the monitoring a high toxicity medication as it's own independent Dx's to help drive up the MDM. To me this would only increase the Risk to Moderate for the condition, not its own standalone issue.

Does anyone have substantiating documentation?


Thank you in advance!

 

[thomas7331]

I would not allow that. The diagnosis associated with monitoring a medication is the problem (or problems) for which the patient is taking the medication. Monitoring medication is part of a treatment plan for a diagnosis, it not a diagnosis itself. It wouldn't be appropriate to count one diagnosis for the problem and then a second for the monitoring unless you have documentation that the medication is causing a new problem/symptom or some kind reaction or side effect in the patient.

The work of monitoring a medication is captured throughout the elements of the E&M code - in the additional history the provider must take to evaluate the effect of the medication, in the exam that the provider does to check the patient's health, and towards the MDM data section for the labs and other test to check for toxicity as well as in the risk section for that risk that the medication poses. With all of those elements contributing to the level of the E&M, the provider is receiving 'credit' for the work in monitoring the patient and there shouldn't be a need to pad it with additional MDM by adding an additional diagnosis point for something that's not a diagnosis.

 

[A622220]

I would not allow that. The diagnosis associated with monitoring a medication is the problem (or problems) for which the patient is taking the medication. Monitoring medication is part of a treatment plan for a diagnosis, it not a diagnosis itself. It wouldn't be appropriate to count one diagnosis for the problem and then a second for the monitoring unless you have documentation that the medication is causing a new problem/symptom or some kind reaction or side effect in the patient.

The work of monitoring a medication is captured throughout the elements of the E&M code - in the additional history the provider must take to evaluate the effect of the medication, in the exam that the provider does to check the patient's health, and towards the MDM data section for the labs and other test to check for toxicity as well as in the risk section for that risk that the medication poses. With all of those elements contributing to the level of the E&M, the provider is receiving 'credit' for the work in monitoring the patient and there shouldn't be a need to pad it with additional MDM by adding an additional diagnosis point for something that's not a diagnosis.

Thank you for confirming Thomas!