Cardiology Coding Alert

Question: If a patient’s prescribed medication needs a prior authorization from their insurance, can the pharmacy do that, or does it have to be from the prescribing physician’s office?

Texas Subscriber

Answer: Prior authorizations for medications have to be sought by the physician’s office — but not necessarily by the physician. Melissa Kirshner, MPH, CPC, CPCO, CDEO, CRC, CFPC, CPMA, COBGC, CEMC, CPC-I, executive director at Olympia Medical LLC, says that in her workplace, two ambulatory care clinical pharmacists spend two days a week in the office; instead of seeing patients, they just spend the work hours on the phone navigating prior authorizations. “If I walk down the hall, usually their door is shut, because they’re on the phone fighting for patients to get their medications.”