tci Part B Insider - 2012 Issue 35

Reader Question: Dosage Size Doesn't Dictate 'Prescription Strength' MDM

Question: I have a provider who has stated that if he recommends that a patient take OTC meds at prescription strength, such as Ibuprofen, this qualifies as moderate for medical decision-making. I am looking for some guidance on this. Answer: Moderate decision-making involves other factors besides the risk. In the typically applied carrier audit grid, there are three components that determine MDM; the number of diagnostic and management options, the amount and complexity of data, and finally the level of risk. He is correct that recommending prescriptive therapy can be moderate risk. However, at least two of the areas...

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