Wiki OTC v Rx

[wynonna]

According to AMA audit tool, are we no longer seeing OTC as low MDM?
I mean in the case of a patient with comorbidities which have to be considered. If so, would that be moderate MDM and how should OTC management be documented?
(As in the case when patient has DM or hypertension, and an OTC can affect patient's blood sugar or blood pressure)
THANK YOU

 

[jkyles]

According to AMA audit tool, are we no longer seeing OTC as low MDM?
I mean in the case of a patient with comorbidities which have to be considered. If so, would that be moderate MDM and how should OTC management be documented?
(As in the case when patient has DM or hypertension, and an OTC can affect patient's blood sugar or blood pressure)
THANK YOU

Hi there, the AMA took OTC drugs off the list examples under risk because the risk will vary based on the patient's condition. The example AMA reps have given during presentations is ibuprofen: low risk for a patient without any serious health conditions, high risk for a patient on blood thinners or who has chronic renal failure.

 

[csperoni]

OTC meds are low risk in almost all circumstances.
If physician indicates an OTC med and documents that it can impact the other problems (maybe even adjusting the medication), then it is possible for OTC meds to be moderate.
I did find this AAFP reference:
"If you are billing based on MDM, you can include decisions about prescription medications, but over-the-counter (OTC) medications generally don't meet moderate complexity. If you use OTC medications in that context, just state why the decision was higher risk. A prescription for an OTC medication for insurance coverage purposes does not meet this threshold."