E/M question -- prolonged service code

A patient visits a family physician at least twice a month. He has gone through 2 separate surgical procedures for his spine separated by 3 years. He comes to doc's office usually in severe pain. The doctor examines him thoroughly - looking for his overall health status with respect to nutrition and hydration, side effects of his medications, complications from his systemic illnesses, the level of his discomfort, the state of his weight, blood pressure, lipids, Skin, bladder, CNS, Psych, and, of course, the musculoskeletal system. He puts him on a lumbar traction device, start him on 250 ml of saline with the following added to the bag: Ketorolac 60 mg, Orphenadrine 60 mg, Infusible Multivitamins, and Magnesium Sulfate 12 mEq.

While the intravenous infusion is going, and after the traction session is finished (usually 20 minutes), the patient continues to be monitored with vital signs every 15 minutes, and a brief examination of the mentation and pain level plus mobility every 20 minutes.

This patient ends up spending almost 180-200 minutes in the office: the first 30 minutes or so going over the CC/HOPI, Medication Reconciliation, 14-point ROS, physical examination, review of tests and X-Rays at times, and then discussions with the patient and his wife about the recommended plan of care. The rest of the time is spent in delivering the treatments and monitoring the patient.

Please let me know if prolonged service codes can be billed along with the E/M code. And also, if I can code prolonged service codes (99354, +99355), can I also bill separately for traction (97012) and IV-drugs (96365, +96366). Or if I can code only the E/M + prolonged, and no other IV / traction service is to be billed?

prolonged services

You can only use prolonged services for time the physician spent face to face with the patient, not the time the patient was in the office.

Search "prolonged" in the search box for a longer discussion of that.

Do bill for the infusions/medications.