Wiki Prescription Drug Management - Prenatal Vitamins

Create Wiki
A

abrookner232@gmail.com

Contributor
Messages
15
Location
West Palm Beach, FL
Best answers
0
Are prenatal vitamins that are prescribed a low or moderate level of risk? I initially thought it would be moderate and considered prescription drug management. However, I am being told that since prenatal vitamins are also available over the counter, this is a low level of risk. Basically, the risk does not change based on how the vitamins are obtained, and the general clinical risk is the same regardless (unless the provider documents the specific risk). Does anyone have any knowledge on this?

Any feedback on this is appreciated.
 
Hi there, the treating provider needs to determine and document risk based on the circumstances of the encounter. Here's an excerpt from a CPT Assistant 11/2022 article regarding whether an OTC medication that was prescribed is low or moderate risk.
The physician is responsible for assessing (and documenting) the level of risk of the services to be performed, including medicine management (prescription or OTC), based on the patient’s specific risk factors and the associated risks typically seen with the prescribed or OTC drug(s) for that particular patient.
Click to expand...
Providers need to understand that the example list in the risk column does not create an automatic or one-size-fits all level of risk that coders can use to assign risk.

Regarding OTCs in particular, the CPT editorial panel removed them when it updated the list of risk examples because an OTC can be low, moderate or even high risk depending on the circumstances.
 
I'm not sure I understand the reasoning for removing OTC drugs, but keeping prescription drug management on the MDM table if both can be low, moderate, or high levels of risk. Does CPT or the AMA have an article that explains this more?
 
Last edited:
Here are some reputable resources, even if not from AMA, as well some prior forum discussions about this:


In my experience, OTC meds will be low risk ALMOST of the time. Renewing a topical cream/ointment might be considered minimal risk. Only if the provider documents an unusual situation would I consider OTC meds moderate risk. It is based on the documentation on that specific encounter. For example, an 85 y/o patient being told to take OTC ibuprofen also on blood thinners could have a higher risk than a 25 y/o healthy patient asking for renewal of Rx valtrex cream.

Going back to your original question, unless the provider documents otherwise, I would consider a prescription for PNV low risk.
 
Last edited:
abrookner232@gmail.com said:
I'm not sure I understand the reasoning for removing OTC drugs, but keeping prescription drug management on the MDM table if both can be low, moderate, or high levels of risk. Does CPT or the AMA have an article that explains this more?
Click to expand...
I don't either. Considering how many questions they still get about it I'm surprised they haven't taken it out.

Here is a set of FAQs that includes the guidance re: selecting risk in regards to Rx management on page 5. https://www.ama-assn.org/system/files/cpt-e-m-advancing-landmark-webinar-faq.pdf

Sorry I can't share the entire CPT Assistant article, the AMA gets cranky about oversharing of its paid content.
 
Last edited:
You must log in or register to reply here.
Top