decisionhealth Newsletters, decisionhealth - 2010 Issue 8 (August)
Ask the Expert: When to count high-risk drug management on E/M Table of Risk
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Article Overview
This brief Ask the Expert article addresses E/M medical decision-making risk and the Table of Risk, focusing on when drug therapy management may be considered high risk and what documentation should support that assessment. It is relevant to physicians, auditors, coders, and compliance staff who review E/M services and payer guidance from organizations such as Medicare Administrative Contractors and Palmetto GBA.
Why This Topic Matters
Accurate E/M risk leveling affects audit outcomes and documentation quality. The article helps readers understand the general conditions under which drug therapy monitoring may be considered, and it highlights the importance of payer-specific policy and clear chart support.
What You Will Learn
- How E/M medical decision-making uses the Table of Risk as part of audit review.
- Why active management and documentation matter when assessing drug therapy monitoring.
- What kinds of payer policies may influence risk interpretation.
- What types of chart elements should be visible when intensive monitoring is documented.
Who Should Read This
- Physicians
- Medical coders
- Coding auditors
- Compliance staff
- Revenue cycle staff
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