Modifier 27 | Multiple Outpatient Hospital E/M Encounters On The Same Date

Modifier 27 describes multiple outpatient hospital E/M encounters on the same date. It indicates that a patient has received more than one E/M service in the same hospital, on the same day, with different providers. This can include services in different hospital departments, such as a hospital-based clinic or the ED.

1. What is Modifier 27?

Modifier 27 is a CPT code modifier used in medical billing and coding to indicate multiple outpatient hospital E/M encounters on the same date.

It is appended to a separate, subsequent, and distinct E/M service if the patient receives more than one E/M service in the same hospital, on the same day, with different providers.

Multiple E/M services for the same patient on the same day with different providers can include services in different hospital departments, such as a hospital-based clinic or the ED.

2. When to Use Modifier 27?

Modifier 27 is used when a patient receives multiple E/M services on the same day in the same hospital with different providers.

It is important to note that modifier 27 should not be used to report multiple E/M services that the same provider performs for the same patient on the same day. Likewise, it should not be appended to an E/M code for a subsequent visit at a different hospital.

Modifier 27 only applies to the subsequent E/M visit when the first visit was at another hospital. Therefore, it is essential to check individual payer guidelines to determine those that will reimburse for E/M services with modifier 27.

3. Official Description

The official description of modifier 27 is “multiple outpatient hospital E/M encounters on the same date.”

4. Examples

Example 1: A patient visits the hospital’s ED in the morning and receives an E/M service from one provider. Later in the day, the patient visits the hospital’s clinic and receives another E/M service from a different provider.

Modifier 27 should be appended to the second E/M service code in this case.

Example 2: A patient visits the hospital’s clinic in the morning and receives an E/M service from one provider. Later in the day, the patient is admitted to the hospital and receives another E/M service from a different provider.

Modifier 27 should not be appended to the second E/M service code in this case.

5. Documentation Requirements

To use modifier 27, the medical record documentation must support the separate, subsequent, and distinct E/M service.

The documentation should include the date of service, the location of service, the name of the provider who performed the service, and the reason for the service. It is also essential to document the medical necessity of the service and the patient’s condition.

6. Billing

To bill for E/M services with modifier 27, the code for the E/M service should be appended with modifier 27.

The claim should also include the date of service, the location of service, the name of the provider who performed the service, and the reason for the service. Again, it is crucial to follow individual payer guidelines for billing E/M services with modifier 27.

7. Common Mistakes

One common mistake when using modifier 27 is appending it to an E/M code for a subsequent visit at a different hospital. Modifier 27 only applies to subsequent E/M visits when the first visit was at the same hospital.

Another mistake is using modifier 27 for multiple E/M services that the same provider performs for the same patient on the same day.

It is important to check individual payer guidelines to determine those that will reimburse for E/M services with modifier 27.

8. Other Modifiers Related to Modifier 27

Other modifiers related to modifier 27 include modifier 25 and modifier 59. Modifier 25 indicates a significant, separately identifiable E/M service on the same day as another procedure or service. Modifier 59 is used to indicate a distinct procedural service.

9. Additional Tips

When using modifier 27, it is important to ensure that the documentation supports the separate, subsequent, and distinct E/M service. It is also essential to follow individual payer guidelines for billing E/M services with modifier 27.

Finally, it is important to avoid common mistakes, such as appending modifier 27 to an E/M code for a subsequent visit at a different hospital.

10. Conclusion

Modifier 27 is a CPT code modifier that indicates multiple outpatient hospital E/M encounters on the same date.

It should be appended to a separate, subsequent, and distinct E/M service if the patient receives more than one E/M service in the same hospital, on the same day, with different providers.

Follow individual payer guidelines for billing E/M services with modifier 27 and ensure the documentation supports the separate, subsequent, and distinct E/M service.