Orthopedic Coding Alert

Question: What does the plus symbol in front of some evaluation and management (E/M) service codes signify?

Maine Subscriber

Answer: The + symbol before each of these codes means that they are “add-on” codes, which cannot stand alone, explains Linda Martien, CPC, COC, CPMA, AAPC Fellow. Always use an add-on code in addition to an appropriate base code.

For instance, 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; medical decision making of moderate complexity …) would be your base code and +99354 (Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour …) would be the add-on code if the provider spent 30 minutes to one hour in prolonged service, according to Martien.