Gastroenterology Coding Alert

Question: Our gastroenterologist performed a level-three E/M service on a new patient last week. The visit lasted 45 minutes, yet CPT estimates the gastroenterologist would spend only 30 minutes of face-to-face time with the patient for a level-three new patient E/M service. Can I append modifier -21 (Prolonged evaluation and management services) to the E/M code to account for the extra time?

Mississippi Subscriber

Answer: No, you cannot. Just report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; medical decision making of low complexity) for the E/M service and drop the claim in the mailbox.

Reporting modifier -21 (Prolonged evaluation and management services) for extra E/M time under 30 minutes is not allowable in this case. Use modifier -21 for "the highest level of evaluation and management service," according to CPT, meaning that you can only use it in conjunction with level-five services.