Medical Decision Making

We have an ongoing debate with regard to prescription drug management and establishing medical decision making. The question is the patient that presents with a sore throat or URI. An antibiotic is prescribed to treat the acute illness. Does the act of prescribing a drug constitute prescription drug management and therefore moderate medical decision making?

Prescription drug management

There are 3 boxes that make up your choice of medical decision making. Box C (Risk of Complication and/or Morbidity or Mortality) which you are quoting from, is just one. You can not make a choice for level of MDM until, the other 2 boxes (1. Number of Diagnosis or Management Options and 2. Amount and/or Complexity of Data to be reviewed are addressed. To qualify for a given type of MDM, 2 of the 3 elements in the table must be either met or exceeded.

Medical Decision Making

In the instance of the patient that presents with a sore throat or URI symptoms, the condition is new to the provider with no additional work-up. That with the provider's belief that writing a prescription constitutes prescription drug management fulfills 2 out of 3 criteria for moderate medical decision making. Our question is, does the act of putting pen to prescription pad truly equate prescription drug management? We are having difficulty justifying prescription drug management in the acutely ill patient that is given a standard regimen of antibiotic with the expectation that the acute illness will resolve and no further management is needed.

MDM and prescription drug management

Your provider is correct: putting pen to prescription pad is exactly what prescription drug management is.

I understand your concern: otitis, conjuctivitis, URI with a codeine cough syrup: all have MDM of moderate. And if the provider had a detailed history, then it ends up being a 99214. Many providers prefer to use a 99213, because they say the nature of the presenting problem wasn't that serious. Some auditors question it, as well, particularly when the patient is young and otherwise healthy.

The guidelines essentially say that the OM is more serious than a patient with hypertension in good control.