Neurosurgery Coding Alert

See why 30 minutes more than usual is the magic requirement. If your neurosurgeon spends more continuous time with a patient than what's specified for 99215 or 99225, you should consider appending modifier 21 --" but this won't be the case in 2009. CPT eliminates modifier 21 and directs you to go straight to prolonged service codes instead. Welcome Simplified Method Modifier 21 (Prolonged evaluation and management services) was an informational code and does not require carriers to give you extra reimbursement. "We don't use modifier 21 anyway," says Joyce A. Shea, senior manager for Patient Financial Services at Impulse Monitoring, Inc. in Columbia, Md. Part of the reason is you could only use modifier 21 with the highest level E/M codes in a grouping; for example, 99205, 99215, 99245, etc. Per CPT 2008, Appendix A, you would use the modifier only with "the highest level of E/M service within a given category - " and only on an E/M code. Part of the reason why many practices haven't used modifier 21 is they rarely report these highest level E/M codes. Reason for confusion: If the time documented did not exceed 30 minutes beyond the CPT allotted time, you could not append modifier 21 to the E/M, experts say.-Because modifier 21 was redundant in some cases and mysterious to some, eliminating this modifier simplifies your decision. Embrace More Specific Prolonged Services Benefit of new way: Using a +99354-+99359 (Prolonged physician service in the office or other outpatient setting ... ) code, rather than modifier 21, also 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. Here's How Single Method Works Providers should code the level of care based on medical necessity and time. Report prolonged E/M services 30 minutes beyond the usual service for direct and indirect patient care using prolonged services codes +99354-+99359. Example: The neurosurgeon sees a former patient who was in an automobile accident. At the time of the accident, the patient didn't seek medical attention but has begun to have intermittent back and neck pain. The physician does a full history and examination and documents medical decision making. 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, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity - Usually, the presenting problem[s] are of [...]