# Modifier 21?



## helen

Prolonged EM service.
Does this modifier even exist anymore?


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## j.berkshire

Nope, this modifier was deleted; see Appendix A in your CPT book.  It's replaced with the prolonged care codes, 99354-99357


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## RebeccaWoodward*

No. This became obsolete 2009.


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## helen

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)?


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## sbicknell

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


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## helen

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.


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## RebeccaWoodward*

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


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## sbicknell

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


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## helen

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


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## sbicknell

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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