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dmdahlgren

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I am a new coder and I have some charts where the physician states medication reconciliation was performed. Does this count as the physician ordering a prescription for the E&M calculator?
 
Doesn't that just mean that the physician reviewed the patients medications with them, not whether or not to continue/discontinue/change the medication? I would need more documentation than that, but just based off of what you have here, I would say no, it is not prescription management.
 
If the provider is simply reconciling the medication list, that is NOT prescription drug management. Key word "management". Listing prescriptions without evaluation of the problem is not managing the medication. Several MACs gave guidance on this:
NORIDIAN: Q7. Please explain further "prescription drug management."A7. Prescription drug management does not require a new drug, a new dosage, or a discontinuation of a current prescription. The medical record will show the physician work to determine the medical necessity of the prescription drugs. An encounter documented as only a prescription refill without documentation of a problem addressed would not suffice. The AMA defines a problem addressed in part as "A problem is addressed or managed when it is evaluated or treated at the encounter by the physician or other qualified health care professional reporting the service." You can also count prescription medications considered but not given could be patient choice, possible drug interactions, etc. Prescription drug management does not include drugs injected during the current or subsequent encounter.

NGS: Please define prescription drug management relative to MDM. Answer: In order to count prescription drug management there must be documentation of at least one of the following factors: A prescription drug that the practitioner is evaluating the appropriateness of using for the patient; and/or continuing to prescribe for the patient. Documentation on the prescription drug(s) that are being considered and the reason why they are being considered. Documentation of a decision to initiate a new prescription drug(s). Documentation of a practitioner’s decision to discontinue a prescription drug or to adjust the current dosage relative to changes in a patient’s condition. The patient condition, possible adverse effects, potential benefits, etc. of the patient using this prescription drug.Prescription drug management is based on the documented evidence that the provider has evaluated medications during the E/M service as it relates to the patient’s current condition. Simply listing medications that patient takes is not prescription drug management. Credit will be provided for prescription drug management as long as the documentation clearly shows decision-making took place in regard to those medications.

Novitas: 4. When can prescription drug management be credited in the medical decision-making risk of complications chart?Credit is given for prescription drug management when documentation indicates medical management of the prescription drug by the physician who is rendering the service. Medical management includes a new drug being prescribed, a change to an existing prescription or simply refilling a current medication. The drug and dosage should be documented as well as the drug management.If medications are just listed in patient’s medical record, credit is given for past history.
 
dmdahlgren said:
I am a new coder and I have some charts where the physician states medication reconciliation was performed. Does this count as the physician ordering a prescription for the E&M calculator?
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It is not necessary to order a prescription, whether new prescription or renewal, in order to satisfy the criteria for prescription drug management. The key word is prescription drug management.

Medication reconciliation is not simply the practice of copying-and-pasting a patient's medication profile into the patient's encounter note.

According to https://www.ncbi.nlm.nih.gov/books/NBK2648/,

Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.
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If we assume the provider knows what medication reconciliation is (why shouldn't we?), and if we assume the provider is in fact performing medication reconciliation (why shouldn't we?), then the provider is likewise performing prescription drug management. That is not to say that medication reconciliation = prescription drug management. Rather, medication reconciliation falls under the category of prescription drug management.

If the provider states they have performed medication reconciliation (e.g., “medication reconciliation was performed”), that qualifies as prescription drug management, as the physician attests to have completed all those five steps listed.

The physician does not have to spell out and write everything out, which is a colossal waste of time. Rather than detailing how they accomplished step 1, step 2, step 3, step 4, and step 5, the physician writes, "Medication reconciliation was performed". Takes way less time to state the same thing. Are we going to assume the physician actually knows what medication reconciliation is? Yes, we are. Are we going to assume they did what they say they did? Yes, we are.
 
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I disagree that clinicians are always making medical decisions about the prescriptions during medication reconciliation. While they may do so sometimes, I would not consider "medication reconciliation performed" in an EMR to mean they evaluated the appropriateness or dosage of those medications in relation to the problem it is treating.
Example:
Patient being seen at urgent care for cough. Patient is also diabetic and has a history of seizures. The urgent care clinician performs medication reconciliation to ensure OTC Robitussin will not interfere with any other medications previously prescribed. The urgent care clinician is not evaluating whether the neurologist's anti-seizure prescription is the appropriate medication nor the appropriate dose. The urgent care clinician is not evaluating whether the endocrinologist's prescriptions for diabetes are the best treatment for the patient.
I inquired with several clinicians and all agreed that medication reconciliation is not the same as prescription drug management.
I would love to hear some other opinions and references on this.
 
csperoni said:
I disagree that clinicians are always making medical decisions about the prescriptions during medication reconciliation. While they may do so sometimes, I would not consider "medication reconciliation performed" in an EMR to mean they evaluated the appropriateness or dosage of those medications in relation to the problem it is treating.
Example:
Patient being seen at urgent care for cough. Patient is also diabetic and has a history of seizures. The urgent care clinician performs medication reconciliation to ensure OTC Robitussin will not interfere with any other medications previously prescribed. The urgent care clinician is not evaluating whether the neurologist's anti-seizure prescription is the appropriate medication nor the appropriate dose. The urgent care clinician is not evaluating whether the endocrinologist's prescriptions for diabetes are the best treatment for the patient.
I inquired with several clinicians and all agreed that medication reconciliation is not the same as prescription drug management.
I would love to hear some other opinions and references on this.
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I sent an e-mail to AMA (cptonline@ama-assn.org). Awaiting their response.

Hello,

I have a question regarding medication reconciliation as it relates to the determination of E/M complexity.

If a licensed independent provider documents in the patient’s visit note that they have performed medication reconciliation (e.g., “medication reconciliation was performed”), excluding any other activities that qualify as prescription drug management, does medication reconciliation by itself qualify as “Prescription Drug Management” as it relates to the determination of E/M complexity?

Thank you for your assistance.

Sincerely,
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carlystur said:
Doesn't that just mean that the physician reviewed the patients medications with them, not whether or not to continue/discontinue/change the medication? I would need more documentation than that, but just based off of what you have here, I would say no, it is not prescription management.
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I do not feel that it counts towards prescription management but my supervisor insists otherwise which is an odd position to be in. Hopefully I can get this resolved.
 
Hi Dmdahlgren
All data is good listed above but use differ Z codes for prescription renewed dx Z76.00 and management drugs reconciled dx Z51.81 plus use as the last diagnosis on claim not first.
I hope helped somewhat on the topic
Lady T
 
Fun discussion. This is assuming we are talking about office/outpatient? I think the answer is "it depends". With the answers and discussion here, we can see it is one of those grey area situations. As an auditor, I could see counting this if they documented how it contributed to the management of the patient or in relation to other meds this provider was managing, prescribing, etc. However, if just listing it out as part of the history, I would not count it. It will always go back to the documentation of the specific encounter. It is a patient safety measure. In some cases as stated above the CPT II codes would be added depending on the type and place of service.

I would cite some of the same MAC links as @csperoni.

Another thought, if this process takes extra time, there is extended discussion around the medications, and it is impacting MDM, you could think of using time. I think of how many charts I have seen where a patient is taking 20+ medications and how that would impact the management of the patient depending on the cc and reason for the visit, etc. Even if the provider is not the one prescribing all of them.

This NAMAS post has some good ideas around Rx management: https://namas.co/wp-content/uploads/2022/10/Modifier-25-RX-Management.pdf
 
carlystur said:
Doesn't that just mean that the physician reviewed the patients medications with them, not whether or not to continue/discontinue/change the medication? I would need more documentation than that, but just based off of what you have here, I would say no, it is not prescription management.
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I agree. They guidelines clearly state the management of a prescription medication. Now I would count this for TCM if that was the reason for the visit.
 
I happened on this thread in my search for some guidance/guidelines for prescription drug managment, which I've yet to find.
I came across this:
https://www.aapc.com/codes/coding-n...ription-drug-management-advice-174827-article
Stating that " CPT® currently has no guidelines for this".

Seeing how many times through the years this question has been asked and reading the conflicting views all coders have with this, it's a little crazy that guidelines haven't been made to clarify what we need to know. Having to stop, search, debate it, seems to be a bit of a waste of our time as coders. Also without solid information at hand, that makes it difficult for us to state a case to a provider if they question the why we didn't factor in prescription management for their MDM.

In the end after researching, I'm still uncertain as to when to count or not count prescription managment toward the MDM.

I do appreciate this discussion, everyones input and thoughts and to read the different views on the matter.
 
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