Pulmonology Coding Alert

Knowing which codes qualify for -27 is your first step toward success.

When your physicians provide multiple evaluation and management (E/M) services for a patient in multiple outpatient settings on the same day, don’t assume you can only code for one encounter. Modifier 27 (Multiple outpatient hospital E/M encounters on the same date) can come to your rescue, if you know how to use it.

Note: Please remember that this code is not reported by physicians, only the facility under OPPS.

Guideline: The CMS handbook states that multiple services with distinct E/M encounters performed in multiple outpatient hospital settings on the same date can be reported by adding modifier 27 to each outpatient and/or E/M code(s). 

Key points: Keep these simple instructions in mind when deciding whether modifier 27 is appropriate:

• Use this modifier if a patient was seen in two different hospital-based clinics on the same date of service (hospital emergency department, outpatient clinic, etc.)

• Only append modifier 27 to E/M service codes within the range of 92002-92014, 99201-99499, and with healthcare common procedure coding system codes G0463 (Hospital outpatient clinic visit for assessment and management of a patient), G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination), and G0175 (Scheduled interdisciplinary team conference [minimum of three exclusive of patient care nursing staff] with patient present)

• Append this modifier to the second subsequent E/M code when more than one E/M service is provided that same day in the same or different hospital outpatient setting.

• This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date for professional billing; it should only be used for facility billing.

Example:Ms. Smith, a 45-year-old female, attends an appointment for a chronic asthma management issue at the hospital chest clinic at 10:00 a.m. She also sees her cardiologists for her cardiovascular issues in the early afternoon.

As the hospital coding specialist, you might be responsible for coding the services provided in all your facilities, including the clinic as well as the ED. Ms. Smith was seen in two different hospital outpatient locations on the same day. First, you would code the E/M for the chest clinic visit. Second, you would report the services that she received in the ED, which included evaluation and respiratory support. Without the use of modifier 27, you might have difficulty in getting the claim reimbursed.

Tip: The use of modifier –27 must be supported by the documentation in the patient’s medical record.