Gastroenterology Coding Alert

Soon, you'll have only the more specific way to report prolonged services.

Have you tried adding modifier 21 onto a 99214 or 99223 that took longer than usual? CPT 2009 eliminates this pitfall by taking you directly into prolonged services codes. Before you start adding +99354 through +99397 onto an E/M service,

check out these changes.

That was then: CPT instructed you to use modifier 21 (Prolonged evaluation and management services) only for the highest level E/M code in a category, and only on an E/M code. If the time documented did not exceed 30 minutes above the

CPT allotted time, you could possibly append modifier 21 to the E/M.

This is now: CPT 2009 deletes modifier 21. The good news is that using a +99354-+99359 prolonged code, rather than modifier 21, provides more description.

"The prolonged E/M service codes clarify whether it was face-to-face time with the patient and specify exactly the time parameters involved," explains Jennifer Swindle, RHIT, CCS-P, CPC-EM-FP, CCP, director of coding compliance/charge

entry for QLIMG, and director of the coding and compliance division of PivotHealth LLC in Garden City, N.Y.

You should code the level of care based on medical necessity and time. Report E/M services 30 minutes beyond the usual service for direct and indirect patient care using prolonged services codes +99354-+99359.

Example: A visit, in which the E/M medical necessity level meets the criteria for 99214 (Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 25 minutes face-to-face with the

patient and/or family), takes 60 minutes.

This visit would be eligible for an additional prolonged service code of 99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first  hour [List separately in

addition to code for office or other outpatient evaluation and management service]) with 99214.

2008 method: In the office setting, you could have used modifier 21 on only 99215 (Office or other outpatient visit for the evaluation and management of an established patient ...), but the visit's medical necessity might not have warranted

reporting this level of care.

If you were one of the few getting paid for 99215-21, CPT 2009 will disappoint you. "Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the

evaluation and management codes," say new CPT notes for 99354 and 99356.