Ambulatory Coding & Payment Report
Reader Question: Multiple Visits
Question: When a patient comes to our breast clinic, three different physicians might see her on the same day, such as a surgeon, an oncologist and a radiation oncologist. The patient stays in the same room, and the physicians come to her but not at the same time. My APC information indicates that visits with more than one health professional and multiple visits with the same health professional during the same session at a single location within the hospital constitute a single visit. How would we code this situation for the facility? Would modifier -27 apply, or can we only charge one facility fee, even though the patient was here for three hours?
Alaska Subscriber
Answer: In the case you describe, only one E/M facility charge is appropriate. However, for Medicare purposes, you can identify any procedures performed during the visit with the related HCPCS code. Because all the services provided during the visit are related, combine the total resources used for the three visits to define facility services under one E/M level.
Modifier -27 (multiple outpatient hospital E/M encounters on the same date) does not apply in this case because it is not recognized by Medicare APCs. For non-Medicare payers, it describes multiple outpatient hospital E/M services for separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date.
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