decisionhealth Newsletters, Part B News - 2011 Issue 6 (June)
Ask a Part B News Expert: Over-the-counter drugs and medical decision-making
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Article Overview
This article addresses a billing and documentation question about evaluation and management medical decision-making, focusing on how prescription writing for a medication that is also sold over the counter may be viewed in the context of risk and management options. It is aimed at coders, billers, and clinicians who need to understand how carrier guidance, medical necessity, and presenting problem considerations can affect level-of-service support. The piece provides expert commentary on the general issue and notes that payer-specific policies may influence interpretation.
Why This Topic Matters
Determining the appropriate level of medical decision-making affects E/M service selection and documentation support. This topic is especially relevant when payer policies vary and when the same medication can be obtained both by prescription and without one.
What You Will Learn
- How the article frames over-the-counter versus prescription drug management in medical decision-making
- Why payer guidance can affect interpretation of risk and management options
- How medical necessity and the presenting problem relate to level-of-service support
- What kinds of documentation considerations may influence the analysis of a prescribed medication that is also available over the counter
Who Should Read This
- Medical coders
- Billing professionals
- Physicians
- Clinical documentation improvement staff
- Practice managers
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