Wiki Billing CPT 99201-99499 with modifier 27

[Andys]

Hi all,

Can any one tell me whether we can bill modifier 27 with E/M services CPT 99201 - 99499.
I searched on the net and all the article I found say we can but for multiple outpatient hospital E/M service. Does multiple outpatient hospital E/M service covers only emergency care & observation care. I'm confused

Your help is appreciated... Thanks....

 

[clinicalanalyst]

Modifier 27

A. Modifier –27 should be appended only to E/M service codes within the range of 92002-92014, 99201-99499, and with HCPCS codes G0101 and G0175.
B. Hospitals may append modifier –27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is “separate and distinct E/M encounter” from the service previously provided that same day in the same or different hospital outpatient setting.
C. When reporting modifier
27, report with condition code G0 when multiple medical visits occur on the same day in the same revenue centers.

Hope this helps!

Laurayne Pugh CPC, CEMC

 

[Andys]

Modfier 27

Thanks Laurayne

But can modifier 27 be appended when 2 different physician of 2 different speciality bill the same E/M service
i.e. supposes Dr. A bill 99213 & on same day Dr. B bills 99214 for the same patient

& also can mod 27 be appended to inpatient hospital setting as all the documents state hospital outpatient setting.

 

[mitchellde]

the 27 modifier is never used on a physician claim it is only for hospital outpatient use, which is ER, and outpatient clinics. it matches to Revenue codes 450 and 510. while a provider may bill only one E&M perday, the facility can bill multiple, it has nothing to do with which provider or how many different providers are involved it only has to do with multiple encounters in the hospital stting. for instance a patient comes to the ER and the facility bills a 450 rev code with a 99283
the same patient returns to the clinic later in the day, the facility bills an additional 510 rev code with a 99214 with a 27 modifier. It gets more complex if a procedure is performed along the way but this
is facility billing. I can go there if you need me to.
If the same patient were attended to by the same physician in both settings the provider can combine the documentations and submit one E&M level.

 

[OBoswell]

Cpc

Hi Debra, i know I'm a little late but I have a question on this topic:
Say if there are 2 different Part B bills for the same E/M level, same, rev code, same beneficiary, same dos. The only things different between the two bills is the principle dx and one bill has the G0 (zero) modifier, and modifier 27 was NOT reported. Are these 2 bills duplicate submissions, or are they payable? Please help, thanks! I'm a RAC for medicare and the people on my team are conflicted on how to handle these situations.

 

[mitchellde]

I would consider this a duplicate submission. If there were 2 encounters on the same day they need to be reported on the same claim. The G0 condition code is for when both encounters occur in the same rev center and is used in addition to the 27 modifier.

 

[OBoswell]

Thanks, but the problem with that is I have reviewed a CMS memo that state that there has to be 2 diff submissions if one claims has the G0 condition code (http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R270CP.pdf, pg 11). In leiu of obtaining medical documentation for every E/M claim, how can a RAC determine a claim duplication just based off of the modifier and/or cond code? I don't want to designate these claims as dups unnecessarily. HELP!!

 

[mitchellde]

The memo is referencing billing one timr OPPS services with repetitive OPPS services on the same day. It states also that all one time services ate reported on the same claim.

 

[Huberm]

Mod 27

Hi Debra,
Regarding the mod 27: It is my understanding that if a patient comes into the ED twice in one day for 2 different problems, you would use the mod 27 for the second visit level. My question pertains to if during the second visit a procedure is performed, how would the mod 25 and the 27 be handled? Which would be applied in the first position? HELP!!!

 

[mitchellde]

Again this is facility ONLY billing
If the pat comes into the ER for a visit say 99283
then pt returns later same or different dx visit level 99213 with a laceration repair
you would have
rev code 450 with 99283 25
rev code 450 with 99283 25 27
rev code 450 with lac repair (CPT Code)
and a condition code G0 is placed
once a procedure is performed in the facility then all E&Ms for the day are appended with a 25 modifier.
so say the patient returned to the clinic instead of the ER and had the lac repair it would be billed the same way except there would be no G0 condition code and revenue center for the second visit would change but the modifiers would be the same.