Wiki Modifier 27..

[racheleporterwilliams]

I am a professional services coder and work at an HMO in California. We use an EMR, but it's not fully functional-only a portion of the EMR was purchased. My Supervisor has inpatient credentials.

The patient has commercial payor insurance. I used -27 on the ER E/M because the patient was seen in the clinic earlier that day, documented in the ER progress note as well as viewing the medical record from the clinic to validate the clinic visit was performed, and the reason for both visits were not the same. Because my employer only allows the provider to code the office visit E/M, -27 was not coded on the office visit. My Supervisor recommends me to take -27 off the ER E/M because -27 should only be placed on the subsequent visit and she showed me the guidelines from CMS. I explained to her the guideline she just spoke of is for Medicare and read her the guidelines from the CPT book. Then she said because I didn't code the office visit along with the ER E/M I should take -27 off.

How would you proceed?

 

[msd9000]

The modifier 27 is intended ONLY for outpatient hospital facility coding, not for physician coding. Therefore, the use of modifier 27 on a physician claim would not be appropriate.

CPT typically allows only ONE E & M per doctor per day, however, stipulates that if the patient is seen more than once, the physician has the ability to "combine" the documentation and code a level of service appropriate with the documentation for both services.

Hope this helps.

Marsha Diamond, CPC, CPC-H, CCS

 

[racheleporterwilliams]

pls don't take this the wrong way
okay, if -27 is not reported by the physician, then why does the CPT guidelines say, '...This modifier provides a means of reporting curcumstances involving evaluation and management services provided by the physician (s) in more than one (multiple) outpatient hospital setting (s)'? If this modifier is intened only for facility coding wouldn't the CPT book say so?

The modifier 27 is intended ONLY for outpatient hospital facility coding, not for physician coding. Therefore, the use of modifier 27 on a physician claim would not be appropriate.

CPT typically allows only ONE E & M per doctor per day, however, stipulates that if the patient is seen more than once, the physician has the ability to "combine" the documentation and code a level of service appropriate with the documentation for both services.

Hope this helps.

Marsha Diamond, CPC, CPC-H, CCS

 

[mitchellde]

The CPT does say this is is facility only if you look in appendix A you will see the 27 listed only under the ASC and outpatient modifiers section. Or at least that is how my book has it listed

 

[racheleporterwilliams]

well, this is news to me...I'm surpised this info was not taught in the workshops I've attended. Thanx

The CPT does say this is is facility only if you look in appendix A you will see the 27 listed only under the ASC and outpatient modifiers section. Or at least that is how my book has it listed

 

[mitchellde]

I teach it in mine!

 

[racheleporterwilliams]

I was able to find Coding with Modifiers-A Guide to Correct CPT and HCPCS Level II Modifier Usage by Deborah Grider 3rd Edition and I couldn't be happier...thanx to all who advised me

I am a professional services coder and work at an HMO in California. We use an EMR, but it's not fully functional-only a portion of the EMR was purchased. My Supervisor has inpatient credentials.

The patient has commercial payor insurance. I used -27 on the ER E/M because the patient was seen in the clinic earlier that day, documented in the ER progress note as well as viewing the medical record from the clinic to validate the clinic visit was performed, and the reason for both visits were not the same. Because my employer only allows the provider to code the office visit E/M, -27 was not coded on the office visit. My Supervisor recommends me to take -27 off the ER E/M because -27 should only be placed on the subsequent visit and she showed me the guidelines from CMS. I explained to her the guideline she just spoke of is for Medicare and read her the guidelines from the CPT book. Then she said because I didn't code the office visit along with the ER E/M I should take -27 off.

How would you proceed?