Ask Dr. Z

In a review of onpatient E/M leveling for cardiology, the providers questioned the risk portion of medical decision-making due to patients being on a Cardizem drip (99223 for initial and 99233 for subsequent hospital visits). The providers believe medications adenosine, IV Lopressor, or Cardizem automatically qualify the patient as "high risk " for MDM and therefore the highest-level E/M should be reported. These drugs are not included in the list of high-risk medications. Is there an expectation that the providers should document the importance of administering these drugs in the care of the patient to substantiate meeting high risk MDM? The providers stated a coder should know to move to high risk if the patient is on telemetry. Please advise.