Medical Decision Making: Drug Therapy Requiring Intensive Monitoring for Toxicity

There are often questions and confusion on what is included and acceptable when choosing “Drug therapy requiring intensive monitoring for toxicity” in the Medical Decision-Making Risk category for Evaluation and Management coding. This article reviews the definition and guidelines as provided by CMS and their Medicare Administrative Contractors (MACs).

1. 1. Risk: High MDM – Drug therapy requiring intensive monitoring for toxicity: Drugs that have a narrow therapeutic window and a low therapeutic index may exhibit toxicity at concentrations close to the upper limit of the therapeutic range and may require intensive clinical monitoring.
      1. 1. Therapeutic agent that has the potential to cause serious morbidity or death
         2. Monitoring is performed for assessment of adverse effects and not primarily for assessment of therapeutic efficacy
         3. May be patient-specific in some cases
         4. Long term or short term
         5. Not less than quarterly
         6. Laboratory test, physiologic test or imaging
         7. History and exam does not qualify
         8. Cytotoxic chemotherapy treatment
         9. The table below is a list of examples of drugs that are approved for monitoring for toxicity – when used for the specific treatment listed (this is not an all-inclusive list)