Wiki Modifier 27 in facility coding

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BikerBarbie64

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Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date - For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in multiple hospital settings on the same date may be reported by appending the modifier 27 to each appropriate level outpatient and/or emergency E/M code (s). This modifier provides the means of reporting circumstances involving evaluation and management services provided by physician (s) in more than one (multiple) outpatient hospital setting (s) (eg, hospital emergency department, clinic). NOTE: This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date.

On the following webpage, (excerpt provided) AAPC allows for two E/M services for return visits to the ED with the same chief complaint. How can this be considered separate and distinct?

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Unique to the outpatient facility side is modifier 27 Multiple outpatient hospital E/M encounters on the same date. In addition, condition “GO” is assigned on the UB-04 claim form when multiple visits from within the same revenue center on the same date are performed. Facilities may be reimbursed when more than one E/M is performed on the same calendar date.​
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For example, a patient arrives in the ED at 10:07 a.m. for complaints of severe headache. Treatment is provided and the patient is discharged. At 7:00 p.m., the patient returns with worsening complaints of severe headache accompanied by nausea, vomiting, and severe photophobia. The patient is treated again and discharged.​
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On the physician side, it’s inappropriate to code and bill for two ED visits for the same physician/physician group; on the facility side, however, coding would be:
99282 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity… *(or the appropriate ED level) for visit at 10:07 a.m.
99282-27 *(or the appropriate ED level) for visit at 7:00 p.m.​
 
hi BikerBarbie64-

I do not have your answer, but I can point out that the AAPC article you are citing is from 2013 and may be outdated.
 
lgardner said:
hi BikerBarbie64-

I do not have your answer, but I can point out that the AAPC article you are citing is from 2013 and may be outdated.
Click to expand...
Thanks for bringing that to my attention. I would hope that if it's still on the AAPC website that it is current.
 
BikerBarbie64 said:
Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date - For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in multiple hospital settings on the same date may be reported by appending the modifier 27 to each appropriate level outpatient and/or emergency E/M code (s). This modifier provides the means of reporting circumstances involving evaluation and management services provided by physician (s) in more than one (multiple) outpatient hospital setting (s) (eg, hospital emergency department, clinic). NOTE: This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date.

On the following webpage, (excerpt provided) AAPC allows for two E/M services for return visits to the ED with the same chief complaint. How can this be considered separate and distinct?

​
Unique to the outpatient facility side is modifier 27 Multiple outpatient hospital E/M encounters on the same date. In addition, condition “GO” is assigned on the UB-04 claim form when multiple visits from within the same revenue center on the same date are performed. Facilities may be reimbursed when more than one E/M is performed on the same calendar date.​
​
For example, a patient arrives in the ED at 10:07 a.m. for complaints of severe headache. Treatment is provided and the patient is discharged. At 7:00 p.m., the patient returns with worsening complaints of severe headache accompanied by nausea, vomiting, and severe photophobia. The patient is treated again and discharged.​
​
On the physician side, it’s inappropriate to code and bill for two ED visits for the same physician/physician group; on the facility side, however, coding would be:​
99282 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity… *(or the appropriate ED level) for visit at 10:07 a.m.​
99282-27 *(or the appropriate ED level) for visit at 7:00 p.m.​
Click to expand...
When patient leaves a facility and returns at a later time on the same date, under facility coding guidelines, this is considered a separate encounter, which is why these would be considered separate and distinct and would warrant the use of the modifier.

The other situation where you may see this is when a patient is seen for multiple outpatient encounters on the same day in different specialty clinics within the same hospital, for example a visit to a primary care physician and a cardiologist in provider-based practices in the same hospital on the same day.
 
a patient arrives in the ED at 10:07 a.m. for complaints of rashes . Treatment is provided and the patient is discharged. At 11 p.m., the patient returns with worsening complaints of rashes with multiple , blanchable areas of erythematous patches treated by different provider . The patient is treated again and discharged. please help me how to code for this type of scenarios
 
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