Prescription Drug Management – Meaning

Practice Management

In the level of risk for MDM, level 4 includes “Prescription drug management”. But what qualifies as prescription drug management?

A new Rx, Rx refill, increasing or decreasing Rx dose, discontinuing Rx, and continuing Rx all qualify as prescription drug management. Any management of prescription medication qualifies as moderate risk.

The Fam Pract Manag. 2019 Jan-Feb;26(1):30, answers this question:

“Q: For the purpose of selecting an E/M code, what level of medical decision making is associated with advising a patient to stop a medication?
A: Any management of prescription medication (other than simply acting on a payer notice regarding a formulary change) qualifies as moderate risk, according to Medicare’s Documentation Guidelines for Evaluation and Management Services. If the level of diagnosis and management options considered or the amount and complexity of data reviewed is also moderate or high, this would support a moderate level of medical decision making overall.”

Other coders/auditors say a provider has performed “prescription drug management” when the provider:

  • Issues a new prescription, changes an existing prescription (dosage change, different med for the same problem, or discontinues), or decides to renew a prescription (refill).
  • says to “continue so-and-so medication” or something similar. Simply listing current meds is not enough.

One auditor says, “Personally, if the provider issues a new prescription, changes an existing prescription (dosage change, different med for the same problem, or discontinues), or decides to renew a prescription, I give them credit. However, some auditors do not give credit for renewing prescriptions. I would argue that the decision to renew is definitely medication management. Simply mentioning the medication list without taking any active action with regards to that list, wouldn’t represent medication management, in my opinion.”

A chart auditor says, “I’m a chart auditor and when I see a Rx refill, Increase/Decrease in dosage, or discontinuation, I give credit for Rx Drug Management. Medication List alone is not Rx Management. It is Past Medical History, and I give them credit in the History.”

In conclusion, a new Rx, Rx refill, increasing or decreasing Rx dose, D/c Rx, continuing Rx all qualify as prescription drug management. Any management of prescription medication qualifies as moderate risk.

 

References

The Fam Pract Manag. 2019 Jan-Feb;26(1):30. https://www.aafp.org/fpm/2019/0100/p30.html

https://www.aapc.com/discuss/threads/prescription-drug-management-change-a-medication.86544/

print