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Modifier 27

  1. #1
    Unhappy Modifier 27
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    I need some help on this modifier. So I have a claim denied.
    Er trip #1 patient came in for other stimulant abuse (F15.10) in the morning

    then ER trip #2 (on the same day) came in for Nausea (R11.0)

    So since the patient came in 2 times within a day, would it be appropriate to append the modifier on the one being denied? I am not sure if the diagnosis are different if it would affect using modifier 27.

  2. #2
    Are you billing for professional or facility services? Modifier 27 is for facility use only, for multiple outpatient E&M visits to a facility on the same date of service. Facility emergency room claims would not fall into this category, and hospitals would normally bill two separate and distinct ER claims. If you're billing for professional claims though, this is not the correct modifier to use. You may need to appeal to the payer with documentation to support separate and unrelated visits, and/or review their policies about coding for multiple visits to the same specialty on the same date. Some payers allow you to use modifier 25 in this situation, but in my experience, even with a modifier it still may require a written appeal to get payment.
    Thomas Field, CPC, CEMC

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