M2003 and M2005: When to Code “1, Yes”

by Kerry Termine, DPT, HCS-D, COS-C, CHS-C

Understanding M2003 – Medication Follow-up and M2005 – Medication Intervention

M2003 – Medication Follow-up identifies if potential or actual clinically significant medication issues identified through the drug regimen review were communicated to the physician/allowed practitioner (or physician-designee) and to the extent possible, if the all the prescribed/recommended actions were completed by midnight of the next calendar day following their identification. M2003 is collected at Start of Care (SOC) and Resumption of Care (ROC).

M2005 – Medication Intervention identifies if potential or actual clinically significant medication issues identified at the time of or at any time since the most recent SOC/ROC were communicated to the physician/allowed practitioner (or physician- designee) and to the extent possible, if all the prescribed/recommended actions that were identified throughout the quality episode were completed by midnight of the next calendar day following their identification. M2005 is collected at Transfer, Death at Home, and Discharge from agency.

Requirements for Coding M2003 and M2005 as “1, Yes”

In order to code 1, yes for both M2003 and M2005 the following must take place:

There was two-way communication for all potential or actual significant medication issues identified during the time period under consideration.

1. 1. Two-way communication means that the clinician(s) communicated to the physician/allowed practitioner (or physician-designee) all identified potential or actual clinically significant medication issues and that physician/allowed practitioner (or physician-designee) returned their communication by midnight of the next calendar day.
   2. Any physician/allowed practitioner (or physician-designee) prescribed/recommended actions for the identified issues were also completed by midnight of the next calendar day (at the latest).

Additional Timing Requirements for M2003

The two-way communication must occur, and the item must be answered within the SOC (or ROC) assessment timeframe to ensure compliance with the Condition of Participation regarding the completion of the comprehensive assessment.

M2003 Example: When to Code “1, Yes”

A clinician identifies a medication issue on day 5 after the SOC, the physician is contacted same day and responds back same day with a plan to resolve the problem. The clinician completes that recommendation by end of day 5. M2003 can be marked as code 1, yes.

M2003 Example: When to Code “0, No”

A clinician identifies a medication issue on day 5 after the SOC, the physician is contacted by midnight of the next calendar day and reports back with a plan to resolve the problem on day 6. The two-way communication could not compliantly be captured at the SOC because it is outside the assessment timeframe and M2003 is marked as code 0, No.

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