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Rheumatology Coding Corner Question: Prolonged Service without Direct Patient Contact, Part 2

  |  Issue: October 2017  |  

An established, 66-year-old male patient is seen in the office for a follow-up visit for his fibromyalgia. The physician makes the decision to prescribe venlafaxine for anxiety and depression, and gabapentin for nerve pain. After the visit, the physician informs his medical assistant (MA) to contact the patient’s insurance carrier because venlafaxine requires a prior authorization. The MA spends 32 minutes on the phone with the pharmacy benefit manager for approval. At the end of the day, the physician reviews the MA’s notes for an update and spends 30 minutes dictating the visit for the patient’s chart.

Does this scenario qualify for billing of a prolonged service without direct face-to-face contact?

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