October 15, 2021
Medication Reconciliation
Why does medication reconciliation need to occur after every discharge?
- Medication errors are a leading cause of increased ED utilization and admissions/readmissions.
- Performing medication reconciliation after every discharge ensures that patients understand any new medications they may have been prescribed, as well as any previously prescribed medications that may have been discontinued or changed.
Who can conduct medication reconciliation post-discharge?
- Medication reconciliation must be conducted by a prescribing practitioner, clinical pharmacist, or registered nurse.
- If a medical assistant, certified nursing assistant or licensed practical nurse completes the medication reconciliation post-discharge, a prescribing practitioner, clinical pharmacist, or registered nurse must sign off on the documentation.
Medical Record Documentation requirements:
- Must include evidence of medication reconciliation and date completed.
- Examples of documentation include:
- Current med list with notation of reconciliation of current and discharge medications
- Reference of discharge meds (i.e., same meds at discharge), or discharge medication list review
- Current medication list and discharge med list and notation that they were both reviewed
- Discharge summary with documentation of reconciliation
- Notation of no medications prescribed upon discharge
- Notation of new medications prescribed and any medications that were discontinued or modified
A claim for Transitional Care Management (TCM) codes (99495 or 99496) or the CPT II Code 1111F satisfy the Medication Reconciliation HEDIS measure (any patient 18 years or older with an eligible inpatient discharge). TCM codes can only be billed if outreach was completed or attempted within two business days and the patient is seen by a provider within 14 days of discharge. The 1111F Code can be billed with any office E/M service if it occurs within 30 days of discharge.
- Minimum Medical Record Documentation requirements of TCM codes:
- Date the member was discharged
- Date of interactive contact (telephonic outreach within two business days of discharge) with the member and/or caregiver
- Date the face-to-face visit was furnished
- The complexity of medical decision making (moderate or high)
- Minimum Medical Record Documentation requirements of CPT II Code 1111F:
- Notation that provider was aware of admission/hospitalization
- Hospital discharge date
- Date of completion of medication reconciliation
- Name and credentials of who completed the medication reconciliation
- Current medication list and documentation of reconciliation of current and discharge medication list
If both a TCM code or care planning service code (99483) and 1111F are submitted for the same discharge, providers will receive reimbursement for both codes for Blue Cross Commercial, Medicare Plus Blue and BCN Advantage members. For Blue Care Network, providers will only receive reimbursement for the TCM or care planning service code because 1111F is not reimbursable for BCN members.
How can MPP help?
- MPP Care Managers are providing the initial outreach to patients after discharge within two business days. This enables the TCM codes to be billed if the patient is seen within 14-days of discharge. This conversation includes discussion of medications, barriers to taking medications (cost, formulary coverage) and any issues or discrepancies are relayed to the patients Primary Care physician.
- MPP Medical Leadership has engaged a Hospitalist Physician Advisory Council with several Hospitalist group leaders across the McLaren system.
- One of the initial topics covered was medications. Hospitalists were asked to communicate back to the PCP the reason for any changes to medications and any new medications prescribed during the hospital stay. Often the PCP is asked to change discharge medications due to cost and formulary coverage issues and they may not be aware of the reason medication was prescribed.