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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
    Default
    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
    Location
    North Carolina
    Posts
    3,126
    Default
    No. This became obsolete 2009.

  4. #4
    Question
    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
    Default
    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
    Location
    North Carolina
    Posts
    3,126
    Default
    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/MLNMAttersArticle...ads/MM5972.pdf

  8. Default
    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

  9. #9
    Default
    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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