Wiki Medical Decision Making question - spending plan

[MnTwins29]

Fellow auditor and I had this discusssion on a chart I am auditing - who's right?

For abd pain, doctor prescribed ibuprofen and wrote patient a script because she needed it to use her flex spending plan for the medication. Because he wrote a script, my co-worker believes this is prescription drug management resulting in a moderate level of MDM. I say this is low level because ibuprofen is available OTC. Whatever the result of this will determine the MDM for this particular chart because the data is limited and the number of diagnoses is multiple.

Thanks for your help in advance!

 

[kbreynolds]

Writing a prescription does not determine medical decision making. You need to go with the medical necessity of the visit. Use only the Presenting problem column on your level of risk table. If your presenting problem is low level of risk then it is low.

 

[eadun2000]

Fellow auditor and I had this discusssion on a chart I am auditing - who's right?

For abd pain, doctor prescribed ibuprofen and wrote patient a script because she needed it to use her flex spending plan for the medication. Because he wrote a script, my co-worker believes this is prescription drug management resulting in a moderate level of MDM. I say this is low level because ibuprofen is available OTC. Whatever the result of this will determine the MDM for this particular chart because the data is limited and the number of diagnoses is multiple.

Thanks for your help in advance!

If he prescribed 800 mg then that is considered a script. If not, then it is just an OTC med and not prescription drug management. Hope this helps

 

[martinni1974]

Always keep in mind the medical decision making must also be in line with the nature of the presenting problem. Just because a script is given does not always = moderate MDM.

 

[MnTwins29]

Thanks!

Thank you for the feedback. Complaint was severe abd pain, pt was following up from CT scan that was "unremarkable" - therefore we felt this would "acute uncomplicated illness or injury (nature of presenting problem). Script for for Ibuprofen 400 mg, so that did not meet that 800 mg threshold. The nature was why I wanted to go low MDM, co-worker felt the need to prescribe was reason for moderate. Thanks for all the input. Sounds like I should do a victory dance!