21 Prolonged E/M Service: This modifier is only appended to the highest-level evaluation and management (E/M) service within its category (eg, 99205, 99245) when the face-to-face service provided is prolonged or greater than the usual required for that service. The time spent must be continuous. This modifier is not reported if the time spent occurs over several sessions during the same day. Modifier 21 would not be reported if the service is prolonged by 30 minutes or more, as this would be reported with the appropriate prolonged service code. When reporting a service with this modifier, be prepared to submit medical record documentation to support the service billed.

A consultation is performed on an inpatient with diabetes at the request of the attending physician. A comprehensive history and physical examination are performed and the medical decision-making is a high level, supporting the use of code 99255. In addition...

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