tci ED Coding & Reimbursement Alert - 2012 Issue 10

Reader Question: It's the total dosage not the pill size that counts for prescription strength OTC medicines

Question: I am looking for assistance on this. I have a provider who has stated that if he recommends that a patient take OTC meds at prescription strength, such as Ibuprofen, this qualifies as moderate for decision making. I am looking for some guidance on this. Thank you in advance.South Carolina SubscriberAnswer: Moderate decision making involves other factors besides the risk. In the typically applied carrier audit grid, there are three components that determine MDM; the number of diagnostic and management options, the amount and complexity of data, and finally the level of risk. He is correct that...

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