Helen3
Contributor
Prolonged EM service.
Does this modifier even exist anymore?
Does this modifier even exist anymore?
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Wiki Modifier 21?
- Thread starter Helen3
- Start date
j.berkshire
Guest
Nope, this modifier was deleted; see Appendix A in your CPT book. It's replaced with the prolonged care codes, 99354-99357
Last edited:
RebeccaWoodward*
True Blue
No. This became obsolete 2009.
Helen3
Contributor
Thanks! Now the question is how do I code (for Medicare) Treatment discussion plans (Pts that have been diagnosed with Breast Cancer) . Since Medicare does not pay consults anymore how can I code the Office visit established pt (99215) with over 40mins but not up over an hour more than 40 mns (99354)?
If these Treatment Discussion/Plan visits meet the guidelines for counseling and coordinating care, then code the entire visit based on time.
Meaning these 40 minute visits would code and bill as a 99215
Counseling and coordinating guideline: if more than 50% of the visit is spent counseling and coordinating (rather than eval and treatemnt), then code the encounter based on time rather than Hist/Exam/MDM.
Must document the total visit time. Must document how much of the time was specific to C&C. Must document "sufficient detail" to support time claimed.
For example, if the visit was 90 minutes and C&C guidelines are met. You would code 99215 (40 min) plus 99354 (prolonged care) for the remaining 50 minutes
Meaning these 40 minute visits would code and bill as a 99215
Counseling and coordinating guideline: if more than 50% of the visit is spent counseling and coordinating (rather than eval and treatemnt), then code the encounter based on time rather than Hist/Exam/MDM.
Must document the total visit time. Must document how much of the time was specific to C&C. Must document "sufficient detail" to support time claimed.
For example, if the visit was 90 minutes and C&C guidelines are met. You would code 99215 (40 min) plus 99354 (prolonged care) for the remaining 50 minutes
Helen3
Contributor
Thank you!! I saw that i(afterwards) in the appendix A (I also meant to say over 40 mins but not quite and hour additional.) So If my doc spends 60 mins. 40 mins 99215- and 20mins-99354 (and all cc guidlines are being met) then would I use mod? When I submitted to medicare as such, they denied. When I initially submitted, I did not use a mod.
RebeccaWoodward*
True Blue
In order to combine 99215 and 99354, the threshold would need to be at least 70 minutes. You only have 60 minutes total.
http://www.cms.gov/MLNMAttersArticles/downloads/MM5972.pdf
http://www.cms.gov/MLNMAttersArticles/downloads/MM5972.pdf
Helen
You have this same Treatment Plan issue under the E&M section "prolonged E&M coding" and are getting duplicate and repeative responses.
I and several others have posted to both to try and make sure you get the info you need but seems to be causing a lot of confusion plus time involved
You have this same Treatment Plan issue under the E&M section "prolonged E&M coding" and are getting duplicate and repeative responses.
I and several others have posted to both to try and make sure you get the info you need but seems to be causing a lot of confusion plus time involved
Helen3
Contributor
Thank you! I didn't mean to cause any confusion. I apologize.