tci Part B Insider - 2019 Issue Q4

Reader Question: Check MAC Advice on Refills and MDM

Question: Can you count a routine prescription refill as a moderate level of risk when determining the level of medical decision making (MDM) for an evaluation and management (E/M) service? SuperCoder Subscriber Answer: If you consult a Medicare chart to determine the level of risk, you’ll see that “prescription drug management” is listed as a clinical example of a moderate level of risk in terms of management options for a given presenting problem The Centers for Medicare & Medicaid Services (CMS) provides an example at  www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf. However, in order to use it as...

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