Wiki H&P w/ Modifier in place of consult

[bill2doc]

Help please. Doctor just heard word that we can bill for H&P with a modifier which would pay more than the new discontinued consult code.... Anyone know what this is about. I've been adjusting my 99254 to 99222, should I have a modifier with that ????

Thank you

 

[mitchellde]

I just checked the CMS website and there is no announcement of a modifer for consultations. However he may be referring to prolonged time codes which have always been available to use in additon to the initial inpatient codes and the new or established office visit codes. These require specific documentation from the provider and yes if all the documentation is there and the medical necessity is good then a visit level plus prolonged time will pay more than the now invalid consult codes did.

 

[bill2doc]

Do you know what the prolonged time modifier would be ??? 22 perhaps ?

 

[mitchellde]

It is not a modifier and you cannot use 22 on an E&M. prolonged time are add on codes. Look in your CPT book at 99354 - 99355, and 99356-99357. They are time based and total time must be a part of the physician's documentation. For office visits it is total face to face time physician to patient, and for inpatient codes it is face to face with the patient plus floor time. The CPT book has guidelines for these codes. But for instance if you have an ESTB patient level 3 which the physician documents as difficult or timeconsuming for a reason and documents 45 minutes for the encounter then you subtract the 15 minutes alloted for the 99213 from the 45 and as long as you have a minimum of 30 minutes after you subtract you may bill a 99213 and a 99354. This pays very well and should be investigated but it needs really great documentation to support these codes.