Last Modified: 2/1/2021
Location: FL, PR, USVI
Business: Part A, Part B
Q. During an evaluation and management visit, what constitutes "prescription drug management?"
A. "Prescription drug management" is based on documented evidence that the provider has evaluated the patient's medications as part of a service. This may be a prescription being written or discontinued, or a decision to maintain a current medication/dosage.
Note: Simply listing current medications is not considered "prescription drug management."
"Prescription drug management" does differ from "drug therapy requiring intensive monitoring for toxicity".
Per the CPT definitions, "drug therapy requiring intensive monitoring for toxicity" is for a drug requiring intensive monitoring which is a therapeutic agent with the potential to cause serious morbidity or death. The monitoring is performed for assessment of these adverse effects and not primarily for assessment of therapeutic efficacy. The monitoring should be that which is generally accepted practice for the agent but may be patient specific in some cases. Intensive monitoring may be long-term or short term. Long-term intensive monitoring is not less than quarterly. The monitoring may be by a lab test, a physiologic test or imaging. Monitoring by history or examination does not qualify. The monitoring affects the level of medical decision making in an encounter in which it is considered in the management of the patient. Examples may include monitoring for a cytopenia in the use of an antineoplastic agent between dose cycles or the short-term intensive monitoring of electrolytes and renal function in a patient who is undergoing diuresis.
Examples of monitoring that does not qualify includes monitoring glucose levels during insulin therapy as the primary reason is the therapeutic effect (even if hypoglycemia is a concern); or annual electrolytes and renal function for a patient on a diuretic as the frequency does not meet the threshold.
NOTICE -- Effective for dates of service on and after January 1, 2021, practitioners will have the choice to document office/outpatient E/M visits via medical decision making (MDM) or time. The Centers for Medicare & Medicaid Services (CMS) is adopting the American Medical Association's (AMA's) Current Procedural Terminology® (CPT®) revised guidance, including deletion of CPT code 99201. The E/M code and guideline changes are specific for office and other outpatient visits and apply to codes 99201-99205 and 99211-99215. Based on the CPT changes, code 99201 is no longer valid for dates of service on and after January 1, 2021, as clinicians may choose the E/M visit level based on either medical decision making or time, both CPT code 99201 and 99202 previously require straightforward medical decision making, therefore the decision was made to delete CPT code 99201.
to view details regarding the 2021 changes to office/outpatient E/M services.
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