1. Eric Fein

    I was told by previous documentation specialist that this specific example would not qualify for monitoring for toxicity. This potential complication is not a toxic build up of diuretic, rather it is a side effect of the medication (volume depletion or hypokalemia). Was that not correct?

  2. Ryan Kroeger

    I also think this is a loose interpretation of the word “toxicity” – but I see it interpreted this way over and over. By this interpretation, checking glucose levels for any patient on insulin is “monitoring for toxicity”. Whether you use the word toxicity or not, I think you could state something like “Continue IV diuresis and intensive hospital monitoring to prevent deleterious effects of treatment”. I don’t think any coder could argue with that.

  3. linda duckworth

    The AMA specially addresses this in the guidelines. Does the very last sentence support the case example used above? The AMA talks about monitoring electrolytes and renal function. Infrequent monitoring is a no, where maybe inpatient is a yes? “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 performed less than quarterly. The monitoring may be performed with a laboratory test, a physiologic test, or imaging. Monitoring by history or examination does not qualify. The monitoring affects the level of MDM in an encounter in which it is considered in the management of the patient. An example may be monitoring for cytopenia in the use of an antineoplastic agent between dose cycles. Examples of monitoring that do 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.”


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