Can you put a 26 modifier on an evaluation and management code such as 99213?

Yes, you can append modifier 26 to evaluation and management (E/M) codes, including 99213, to indicate a prolonged service. Modifier 26 signifies that the physician spent more time than usual with the patient beyond the usual service, resulting in a significant, separately identifiable service.

To use modifier 26 effectively, the prolonged service must meet the following criteria:

1. Time Spent: The physician must have spent at least 50% more time with the patient than the typical time for the E/M code being billed. For instance, if the typical time for 99213 is 30 minutes, the physician must have spent at least 45 minutes with the patient to justify using modifier 26.

2. Complexity of Service: The additional time must be spent providing medically necessary services directly related to the patient's condition. This can involve:

- History taking

- Physical examination

- Medical decision-making

- Counseling and coordination of care

3. Documentation: The medical record must clearly reflect the details of the prolonged service. This includes the nature of the additional services provided and the impact of those services on patient care.

When billing 99213 with modifier 26, be sure to include the appropriate documentation to support the increased time spent and the complexity of the service provided. This will ensure that the claim is processed accurately and without any issues or denials.