Last Modified: 2/10/2018 Location: FL, PR, USVI Business: Part A, Part B
Determining overall risk for medical decision-making
Q. Is prescription drug management enough to establish a moderate level of risk for medical decision-making?
A. The risk of significant complications, morbidity, and/or mortality is based on the risks associated with the following categories:
• Presenting problem(s);
• Diagnostic procedure(s); and
• Possible management options
The assessment of risk of selecting diagnostic procedures and management options is based on the risk during and immediately following any procedures or treatment. The highest level of risk in any one category determines the overall risk, and in the category of possible management options, prescription drug management is at a moderate level of risk.
Source: CMS internet-only manual (IOM), Publication 100-04 Medicare Claims Processing Manual, Chapter 12, Section 30.6
Evaluation and Management Services Guide: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf
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