General Surgery Coding Alert

You-ll have one less modifier to contend with in 2009. If you-re used to adding modifier 21 to E/M codes to capture additional reimbursement when your general surgeon spends longer than normal with a patient, now's the time to revamp your coding. CPT 2009 will delete modifier 21 (Prolonged evaluation and management services), directing you to look instead at the prolonged service codes (99354-99357). Here's the scoop on what you-ll need to know to avoid denials come January. Rejoice in Easier, More Specific Coding In the past you-ve been able to append modifier 21 to the highest level E/M codes in a grouping -- for example, 99205, 99215, or 99245. Modifier 21 was an informational code and did not require carriers to give you extra reimbursement. However, this modifier was often confusing for coders, who didn't always know whether they should add 21 to their E/M services. "Not many practices that I work with were using modifier 21 in the first place," says Heather Corcoran with CGH Billing. Update: Now, you-ll simply turn to a 99354-99357 (Prolonged physician service with direct [face-to-face] patient contact -) code, rather than modifier 21. CPT will change the introductory notes to the 99354-99357 series for 2009, including the new statement, "The use of the time based add-on codes requires that the primary E/M service have a typical or specified time published in the CPT codebook." This change allows coders to provide more description, experts say. "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. Big news: "The most significant change here is that the inpatient prolonged services codes now include both face-to-face and floor/unit time," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program. "The provider must still see the patient in order to use the 99356-99357 codes, but all of the time does not have to be face-to-face. Medicare agreed at the CPT Code Changes Symposium that they would pay for these services even when the time was a combination of face-to-face and floor time. That means that physicians may be able to earn prolonged services for complex patients who require coordination with other providers, review of multiple tests and studies, or coordination of orders with monitoring throughout the day." Another plus: The time you-re counting for these prolonged services does not have to be continuous either. Get Acquainted With 99354-99357 You should [...]