Orthopedic Coding Alert

See why 30 minutes more than usual is the magic requirement. If your orthopedist spends more continuous time with a patient than what's specified for 99215 or 99225, you should not look to modifier 21. Why not: CPT 2009 eliminates modifier 21 and instead directs you straight to prolonged service codes. Welcome Simplified Method Modifier 21 (Prolonged evaluation and management services) was an informational code and does not require carriers to give you extra reimbursement. "We don't use modifier 21 anyway," says Joyce A. Shea, senior manager for Patient Financial Services at Impulse Monitoring Inc. in Columbia, Md. Part of the reason is you could only use modifier 21 with the highest level E/M codes in a grouping, for example, 99205, 99215, 99245, etc. Per CPT 2008, Appendix A, you would use the modifier only with "the highest level of E/M service within a given category" and only on an [...]