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modifier 27

  1. Default modifier 27
    Medical Coding Books
    Hello everyone, can someone tell me when it would be appropriate to attach mod 27? I do both facility and pro-fee for Emergency Medicine, I know that it isn't for pro-fee side, but when would I use it for facility?
    I'm sorry but I am kind of confused with the wording for this modifier in the cpt book. Because it says Hospital resources related to separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27, so does that mean for different places: example seen in ER then seen in clinic or can it be for when seen x2 or more for the same date in the ER?..thank you alice

  2. #2
    Columbia, MO
    It means mutliple oupatient encounters regardless of revenue center. If the patient has 2 ER encounter on the same day the second one needs a 27 modifier. If the patient is seen in the ER (450 rev center) and in the Clinic (510 rev center) on the same day then the second one needs a 27 modifier, If one visit contains a significant procedure then all E&Ms for the day must have a 25 modifier as well. so you could have:
    revenue center 510 99213-25 20610-RT
    revenue center 450 99282-25,27
    revenue center 510 99213-25
    revenue center 450 99282 -25,27 96372
    revenue center 450 99283 - 25
    revenue center 450 99284 - 25,27 96372
    this encounter must also have a G0 condition code for two visits in the same revenue center with a significant procedure.
    In the facility you must look at all encounters for the day regardless of revenue center.

    Debra A. Mitchell, MSPH, CPC-H

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