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Modifier 27..

  1. #1
    Question Modifier 27..
    Medical Coding Books
    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?
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  2. Default
    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

  3. #3
    Default
    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?

    Quote Originally Posted by msd9000 View Post
    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
    Last edited by racheleporter; 02-10-2010 at 12:14 PM. Reason: word change
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  4. #4
    Location
    Columbia, MO
    Posts
    12,843
    Default
    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

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    well, this is news to me...I'm surpised this info was not taught in the workshops I've attended. Thanx

    Quote Originally Posted by mitchellde View Post
    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
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  6. #6
    Location
    Columbia, MO
    Posts
    12,843
    Default
    I teach it in mine!

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    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

    Quote Originally Posted by racheleporter View Post
    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?
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

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