Medical Billing Forum

Coding => Coding => Topic started by: Nmanju on August 05, 2009, 10:41:14 AM

Title: Modifier
Post by: Nmanju on August 05, 2009, 10:41:14 AM
 I want to bill procedure code 99354 (prolonged service) what is the correct modifier for this procedure code? i had earlier used 21 modifer but the payer denied that line item. please suggest.


Thanks,

Manju:-)
Title: Re: Modifier
Post by: PMRNC on August 05, 2009, 11:02:30 AM
The prolonged E/M Code is used IN PLace of the E/M with modifier 21, so you would not use modifier 21 as of CPT 2008
Of course the documentation has to support the E/M elements of the Prolonged E/M code (99354)
Title: Re: Modifier
Post by: PMRNC on August 05, 2009, 01:05:48 PM
Never ask "How do I get paid for a code".  You don't code a claim for reimbursement purposes. The CPT code should reflect the services DOCUMENTED in the medical record. If the record can show the elements and requirements of the Prolonged CPT code of 99354 than that's the code to be used (no modifier). 
You don't state the exact denial reason for the claim, all I can say is that you can't bill out the modifer 21 with the prolonged E/M Code.

Again, you have to code according to what was DOCUMENTED. If it wasn't documented, it wasn't done.
Title: Re: Modifier
Post by: Pay_My_Claims on August 05, 2009, 01:35:23 PM
Never ask "How do I get paid for a code".  You don't code a claim for reimbursement purposes. The CPT code should reflect the services DOCUMENTED in the medical record. If the record can show the elements and requirements of the Prolonged CPT code of 99354 than that's the code to be used (no modifier). 
You don't state the exact denial reason for the claim, all I can say is that you can't bill out the modifer 21 with the prolonged E/M Code.

Again, you have to code according to what was DOCUMENTED. If it wasn't documented, it wasn't done.

AMEN!! AMEN!! AMEN!!!
Title: Re: Modifier
Post by: Steve Verno CMBS, CEMCS on August 08, 2009, 09:03:40 AM
YOU go girl!!

The poster should have read Appendix A of the CPT manual.  It is very clear that it says the following:

Modifier 21 has been deleted. To report prolonged physician services, see 99354-99357)

To reiterate, just because you bill for a service, there is NO guarantee of payment.

It is always your responsibility to make sure your claim is 100% true, accurate, and complete (It says this on the back of the claim form, right next to the pyramid with the eye on top). Keeping on top of cpt code and modifier changes prevents claims denials.