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Modifier 21?

  1. #1
    Default Modifier 21?
    Medical Coding Books
    Prolonged EM service.
    Does this modifier even exist anymore?

  2. #2
    Nope, this modifier was deleted; see Appendix A in your CPT book. It's replaced with the prolonged care codes, 99354-99357
    Last edited by j.berkshire; 06-11-2010 at 09:24 AM. Reason: edit
    Jenny Berkshire, CPC, CEMC, CGIC

  3. #3
    North Carolina
    No. This became obsolete 2009.

  4. #4
    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)?

  5. Default
    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

  6. #6
    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.

  7. #7
    North Carolina
    In order to combine 99215 and 99354, the threshold would need to be at least 70 minutes. You only have 60 minutes total.

  8. Default

    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

  9. #9
    Thank you! I didn't mean to cause any confusion. I apologize.

  10. Default
    no need to apologize. Posted partly for the confusion but also so that you knew you had info/responses coming in both places.

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