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Neurosurgery Coding Alert

Reader Question:

Append -21 Only to Level-5 E/Ms

Published on Fri Nov 19, 2004

Question: Our surgeon performed a level-three E/M service on a new patient last week. The visit lasted 45 minutes, yet CPT estimates the physician would spend only 30 minutes face-to-face with the patient for a level-three new patient E/M service. Can I append modifier -21 to the E/M code to account for the extra time?

Mississippi Subscriber Answer: No, you cannot append modifier -21 (Prolonged evaluation and management services) to a level-three E/M service. You should report only 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history, a detailed examination, medical decision making of low complexity) for the E/M service.

You should use modifier -21 only for "the highest level of evaluation and management service," according to CPT - meaning that you can only use it in conjunction with level-five (99205) services.
 
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