MTM Documentation & Clinical Communication 5 — Questions and Answers
Question 1: A pharmacist completes an MTM encounter and must choose between CPT codes 99605 and 99607. The distinction between these codes is based on:
- Whether the patient has Medicare Part D or commercial insurance
- Whether the patient is new (99605) or established (99606/99607) and the duration of the encounter (Correct answer)
- Whether the encounter was conducted in-person or via telehealth
- Whether the pharmacist identified one or multiple drug-related problems
Correct answer: Whether the patient is new (99605) or established (99606/99607) and the duration of the encounter
99605 is for new MTM patients (up to 15 min), 99606 for established patients (up to 15 min additional), and 99607 for each additional 15 minutes beyond the initial service.
Question 2: Which of the following BEST describes the role of a 'clinical decision support alert' in MTM EHR documentation?
- It automatically adjusts drug doses without pharmacist review
- It flags potential drug-related problems and prompts the pharmacist to document a clinical response (Correct answer)
- It replaces the need for a pharmacist's narrative note
- It submits prior authorization requests to insurance companies
Correct answer: It flags potential drug-related problems and prompts the pharmacist to document a clinical response
Clinical decision support alerts identify potential DRPs and prompt the pharmacist to evaluate and document a clinical response, supporting but not replacing professional judgment.
Question 3: When documenting a patient's social determinants of health (SDOH) that affect medication adherence during MTM, this information is MOST appropriately placed in which section of the clinical note?
- Plan
- Objective
- Subjective (Correct answer)
- Assessment
Correct answer: Subjective
SDOH factors reported by or identified through direct patient interaction are subjective findings that inform the pharmacist's overall assessment and plan.
Question 4: A pharmacist is preparing a written recommendation letter to a specialist physician after identifying an issue outside the primary care provider's scope. The letter should:
- Be addressed to the primary care provider instead, to maintain care team hierarchy
- Identify the specific clinical concern, the relevant medication, and a clear recommended action (Correct answer)
- Avoid mentioning medications by name to protect patient confidentiality
- Include only the patient's medication list without clinical commentary
Correct answer: Identify the specific clinical concern, the relevant medication, and a clear recommended action
Specialist communication letters must clearly articulate the clinical concern, the implicated medication(s), and actionable recommendations to facilitate timely specialist response.
Question 5: During MTM documentation, 'medication nonadherence' as a drug-related problem should be classified as which type of DRP using the Cipolle-Strand-Morley framework?
- Unnecessary drug therapy
- Needs additional drug therapy
- Adverse drug reaction
- Compliance problem (Correct answer)
Correct answer: Compliance problem
In the Cipolle-Strand-Morley DRP framework, medication nonadherence is classified under 'Compliance' (also termed 'Adherence'), reflecting the patient's inability or unwillingness to take medication as intended.
Question 6: A pharmacist documents a 'Needs Additional Drug Therapy' DRP in an MTM note. This is MOST likely because:
- The patient is taking a medication that is not indicated
- A medical condition is present that requires pharmacotherapy but none has been prescribed (Correct answer)
- The current drug dose is higher than necessary
- The patient is experiencing an adverse drug reaction
Correct answer: A medical condition is present that requires pharmacotherapy but none has been prescribed
'Needs Additional Drug Therapy' is documented when a patient has an untreated medical condition that warrants pharmacotherapy not currently prescribed.
Question 7: Following an MTM session, a pharmacist must transmit the CMR written summary to the patient within how many calendar days, per CMS guidelines?
- 7 days
- 14 days
- 30 days (Correct answer)
- 60 days
Correct answer: 30 days
CMS requires that the CMR written summary be provided to the patient within 14 calendar days of the comprehensive medication review encounter.
MTM Documentation & Clinical Communication 5
A pharmacist completes an MTM encounter and must choose between CPT codes 99605 and 99607.
The distinction between these codes is based on: