Wiki Prescription management

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mlchambers

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We have had a discussion among our team about allowing "prescrition management" level on the table of risk if a patient see the physician for an acute complaint i.e. strep throat and the physician prescribes a specific antibiotic and dose.
I consider that prescription management, however, another team member said it has to be for a chronic condition (hypertension) where the patient is checked and medications may be modified.
May I have some opinions?
 
here are my thoughts....is the doctor writing a one time prescription (antibiotic for an ear infection) or adjusting doses of htn and dm meds? If this is the factor that will determine if this visit is a level 3 or 4, I consider the problem and risk of the condition the meds will be treating. Should a infected cat scratch be a level 4, like a patient with bilateral pneumonia or uncontrolled hypertension. If this is your 4th ear infection this year, do you think because it is a "new" problem and the doctor gave you some augmentin, that that should automatically be a level 4? I try to explain it to the docs that way. I have one who has an e/m checklist in his brain...."oooh, new problem, and I wrote a script...I need 4 HPI, 2-3 ROS and 1-2 points of history,add a quick exam with vitals and presto...99214":mad:drives me nuts!

Anyway, this is such a gray area! Check out the examples in the back of the CPT book of what is a 99213 vs a 99214.

In my head, 99215...pt is acutely ill...resp distress...siezure...so 99214, next step down...ear infection? not so much in my book...there may be risk...but....
Look at the examples on the table of risk for Moderate(99214)- pyelonephritis, head injury with brief LOC.

Unfortunately, there really is no right or wrong here...but I suggest you guys compromise and then be consistent and make a policy.
 
Prescription drug management under table of risk, is ordering rx or changes to dosage prescription. So if the antiobiotic is with the need of prescription and provider prescribes it to patient. Then that antiobiotic is under moderate for MGMT option selected. I will try to look for a reference that says this to help you with your providers.
 
Moderate risk

Prescription drug management ... either a new prescription or changing an existing prescription ... is moderate on the table of risk.

I am not a clinician. I do not have a license to practice medicine. I leave it to the provider to document what is medically necessary and do not question his/her decisions. It is the provider's responsibility to document what s/he did, and the coder's responsibility to code what is documented.

That being said, I do agree that the advent of EMR is making it easier for clinicians to OVER document, especially when history is just pulled forward from the chart.

All I can do is educate the physicians to be conscious of medical necessity.

But if the documentation supports a 99214, that is what I code.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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