When auditing MDM, is there a list of drugs that are considered “drug therapy requiring intensive monitoring for toxicity?”
CMS itself has not provided such a list.
Palmetto Medicare has a list of drugs requiring intensive monitoring.
This doesn’t mean other payers will follow this list. Many of the drugs on this list are given to patients chronically, as outpatients, and are not being monitored intensively.
Let’s use bronchodilators as an example. A patient with acute COPD in the ED who is receiving bronchodilators might qualify. A patient on chronic maintenance of the same class of drugs as an outpatient will not qualify.
When deciding whether to assign high risk, both the drug and the monitoring need to qualify. Doing bi-weekly lab or monthly lab tests, or following in the office every three months is not intensive monitoring.
For some of the medications, the initiation of the treatment may require frequent lab tests, phone calls and office visits. As the patient stabilizes, the frequency of lab tests, calls and visits will decrease. There is no definitive citation to guide a coder or clinician in either the list of drugs or what qualifies as “frequent monitoring.”