Orthopedic Coding Alert

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


Mississippi Subscriber

Answer: You cannot append modifier 21 (Prolonged evaluation and management services) to a level-four E/M service. You can only append modifier 21 to the top-level service in any code category (such as 99205 for a new patient office visit).

You should report only 99204 (Office or other outpatient visit for the evaluation and management of a new patient ...) for the E/M service.
 
You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.