Modifier 25 vs 27

[CICIB]

Hello,

Can you please help me with this? A female patient comes to ER with sore throat. The provider order lab. and discharge the patient home. On the way home, the patient is involved into car accident, and returns back to ER with back pain. What modifier is appropriate to use for the second visit? ( it does not specify if the same provider saw the patient) . If you can argument your answer, I will appreciated.

Thank you

 

[sls314]

Modifier 27 would indicate that it is an E/M service performed on separate and distinct hospital encounter from another E/M service on the same date.

Modifier 25 would indicate that the E/M was separate and distinct from another procedure or service.

This fact sheet about Modifier 27 might be helpful: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00145702

(It's from Novitas, but most commercial payers are going to follow Medicare guidelines so it might still be helpful to gain general understanding of Modifier 27.)