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Drug Toxicity...Can I Get Credit?

Updated: Aug 24, 2023

Day in and day out providers are monitor medications that can be classified as toxic to an individual if taken or prescribed inappropriately. Did you know that the 2021 CPT® MDM table lists monitoring for drug toxicity as an example of high risk of morbidity from additional diagnostic testing and/or treatment?


Additional clarification can be found in the AMA document, describing E/M changes 2021: “Drug therapy requiring intensive monitoring for toxicity: A drug that requires intensive monitoring is a therapeutic agent that has 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."


To be sure you're coding qualifies as intensive monitoring, review these examples of conditions listed below:

The drug can cause serious morbidity or death. Monitoring assesses adverse effects, not therapeutic efficacy. The type of monitoring used should be the generally accepted kind for that agent, although patient-specific monitoring may be appropriate, too. Long-term or short-term monitoring is OK. Long-term monitoring occurs at least quarterly. Lab, imaging, and physiologic tests are possible monitoring methods. History and exam are not. Monitoring affects MDM level when the provider considers the monitoring as part of patient management. An example of drug therapy requiring intensive monitoring for toxicity is testing for cytopenia (reduction in the number of mature blood cells) between antineoplastic agent dose cycles.

Examples:

  • 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.

  • Monitoring that does not qualify include monitoring glucose levels during insulin therapy as the primary reason is the therapeutic effect (unless severe hypoglycemia is a current, significant concern); or annual electrolytes and renal function for a patient on a diuretic as the frequency does not meet the threshold.”

Sample Macro:


I am monitoring {insert medication} for drug toxicity due to the potential of {insert reason for monitoring and/or risk to the patient}. This will be achieved through laboratory test {insert laboratory test being monitored} on a {insert weekly, bi-weekly, monthly, quarterly basis}.

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