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Medication Therapy Management Service Codes

 
Code Model

Medication Therapy Management Service(s) (MTMS) describe face-to-face patient assessment and intervention as appropriate, by a pharmacist.  MTMS is provided to optimize the response to medications or to manage treatment-related medication interactions or complications.

MTMS includes the following documented elements:  review of the pertinent patient history, medication profile (prescription and non-prescription), and recommendations for improving health outcomes and treatment compliance.  These codes are not to be used to describe the provision of product-specific information at the point of dispensing or any other routine dispensing-related activities.

99605 Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, initial 15 minutes, with assessment, and intervention if provided; initial 15 minutes, new patient
99606 initial 15 minutes, established patient
99607 each additional 15 minutes (List separately in addition to code for the primary service)

(Use 99607 in conjunction with 99605, 99606)

 

Rationale

Three codes 99605, 99606, and add-on code 99607 and guidelines have been established to report the provision of medication therapy management services (MTMS).  These services are provided by a pharmacist to optimize the response to medications or for the management of treatment-related medication problems or complications.  MTM services are initiated at the request of the patient and/or caregiver, payer, pharmacist and/or other healthcare provider. These codes are not to be used to describe the provision of product-specific information (i.e., product information leaflets) at the point of dispensing or any other routine dispensing-related activities (i.e., professional time related to preparation or delivery of the medication).

In provision of MTMS the review of the pertinent patient history, medication profile will include: evaluation of prescription medications, OTC’s, and herbal medications, and/or physician samples. The pharmacist will inventory the medication list to identify and/or resolve drug therapy problems such as duplications, under- or overdosing, and drug interactions or other types of therapy related issues. The pharmacist may discover medications that need to be added or stopped.  This service may include communication of management recommendations to the prescriber.

Each medication is assessed to determine the effectiveness and the side-effects.  A follow-up monitoring call is included in MTMS to determine if symptoms are resolving, if the patient is experiencing side effects, and to assess compliance.

Assessment will be performed to determine the patient’s adherence to medication recommendations.  The pharmacist will educate the patient and monitor reaction to new and changed prescriptions and over-the-counter (OTC) medications.

Similar to other codes series in the CPT codebook, these codes have been structured to report the initial and more intensive encounter service with code 99605. The subsequent encounter, reported with code 99606 is intended to be reported for services provided which are similar to the initial encounter, with an emphasis on updating information provided at the initial encounter, assessment of the patient compliance and reactions and further evaluation of medications which have been added to the patient’s therapy with those previously assessed.  Add-on code 99607 is reported in addition to codes 99605, 99606 for each additional fifteen minutes of service beyond the initial service.

 
Clinical Vignettes

99605:

A 66 year-old female with pre-existing osteoporosis has been diagnosed with type 2 diabetes and hyperlipidemia. Initial medication therapy assessment and intervention is performed.

Pre Service
Obtaining patient intake information, gathering or preparing materials that will be used during the patient encounter and coordination of other support staff.

Intra Service
Assessment of the patient may include: obtaining a patient medical and medication (e.g., prescription and non-prescription) history; determining appropriateness of medication therapy (supra- or sub- optimal), performing a review of relevant systems; evaluating pertinent lab data; assessing potential or existing drug-drug, drug-disease, and drug-nutrient interactions; establishing and/or obtaining such additional information (e.g., obtaining information from other medical records) as may be necessary; and development of a care plan including recommendations for optimizing medication therapy.

Pharmacist interventions may include: providing education, training and resources; administering medication; formulating a treatment and/or follow-up plan; providing recommendations for disease prevention; and evaluating the patient’s knowledge of medication and willingness to implement recommendations.

Post Service
Documentation of the patient encounter; non face-to-face interventions and recommendations; referrals; communication with other healthcare professionals; administrative functions (including patient and family communications) relative to the patient’s care; and as appropriate scheduling of follow-up appointment(s).

99606:

A 66-year-old female with osteoporosis, type 2 diabetes, and hyperlipidemia is receiving follow-up reassessment after receiving a prior medication therapy management service.

Pre Service
Obtaining patient intake information, gathering or preparing materials that will be used during the patient encounter and coordination of other support staff.

Intra Service
Assessment of the patient may include: obtaining or updating a patient medical and medication (prescription and non-prescription) history; performing reviews of relevant systems; reviewing pertinent lab data; assessing potential or existing drug-drug, drug-disease, and drug-nutrient interactions; evaluating medication-related adverse events and toxicities; assessing medication effectiveness, organizing and interpreting the data; establishing and/or obtaining such additional information (e.g., obtaining information from other medical records) as may be necessary; assessing any recent change in medication therapy or a new medication therapy-related problem; developing a care plan including recommendations for optimizing medication therapy.

Pharmacist interventions may include: providing reinforcement of education, training and resources; modifying therapy; administering medication; formulating a treatment and/or follow-up plan; providing recommendations for disease prevention; re-evaluating the patient’s knowledge of medication; and evaluating knowledge and willingness to follow new recommendations.

Post Service
Documentation of the patient encounter interventions and recommendations; referrals; communication with other healthcare professionals; administrative functions (including patient and family communications) relative to the patient’s care, and as appropriate scheduling of follow-up appointment(s).

99607:

Intra Service
The service(s) continued for an additional 15 minutes with the same patient.


© 2010 Pharmacist Services Technical Advisory Coalition