QUESTION #929: We saw a patient who had Healthy Families. We treated them for asthma and spent over an hour with them, giving them a full exam and going over their medication with them. We received an urgent authorization from the community clinic that the patient came from. We billed the code for a prolonged visit, and the head of the community clinic denied the prolonged visit code. What should we do? Are we using the code correctly?
ANSWER (07/29/09): CMA recommends appealing this denial. You need to make sure that you put the total amount of time spent with that patient on the claim. The prolonged visit code needs really good documentation in order to be paid.