Wiki Risk Assessment

[chesmith]

Can anyone explain what medications are being considered appropriate when Medicare is referring to "Prescription Drug Management" under the RISK table for MDM?

Some people are stating that this only pertains to Controled RXs and others are using refills of current RXs (with no dosage changes), antibiotics, or if there is an RX for something like Lisinopril when there is a dosage change.

Can someone explain what the actual guidelines are when leveling out an E/M and using "Prescription Drug Management"

Thanks in advance for any clarification on this

 

[thomas7331]

There are no 'actual' guidelines on this. You might check with your particular Medicare carrier to see if they have something, but I'm not aware of anything more specific than what's given in the 'Prescription Drug Management' that's listed in the Table of Risk. Specific employers or providers may have their own internal guidelines set up to make these distinctions, but that is not something that is backed up by official published guidelines.

I think the important thing to keep in mind is that these guidelines are just that, they are not statutes or hard and fast rules. I think it's not a good idea to become so caught up in the minutia, such as one type of drug vs. another, that you lose sight of the big picture of the overall medical necessity of the problem and the level of work the provider is documenting as performed. But I'd be interested to hear if anyone else has any input on this.