Wiki 2 visits on one day--what modifiers should be used in ED?

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NIKI01

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Good afternoon,

I want to ask fellow ED coders for input on applying modifiers on 2 ED visits on the same day.

There is a scenario:

Visit #1--The patient came in for abdominal pain and vomiting on 4/1/24. Blood work and U/S were done. Zofran IVP and Saline IV Fluids were used for an hour. The patient was d/c home.
The Facility level was 99284-25, and the Pro-fee level was 99284.

Visit #2--The same patient came in for continuous abdominal pain. The patient was given Pepcid and was d/c home.
The Facility level was 99283-27and the Pro-fee level was 99293.

What other modifiers should be used on the second visit levels?
Any input is greatly appreciated.

Thank you so much, :)
 
TThivierge said:
Hi Nikki
I would try using modifier 27 on 2nd visit to ED on same date. I hope this data helps you
Lady T
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Hello TThivierge,

Thank you so much for the response. :)
Yes, that is correct to use modifier 27 on the Facility level charge Rev Code 0450. That is what I have in my example.
We have different opinions in the office on that topic that is why I am asking for any input. My colleagues saying to use modifier 25 and 27 on the Facility and the Profee level charge on the 2nd visit on the same day. However, I think that 27 can be used on the Facility level only and 25 can be used on the profee level when the procedure was done in the ED by a provider.
 
Hello Nikki,

You would only apply modifier 27 to the facility E/M level and modifier 25 on the Pro-fee E/M level. Modifier 27 does not apply to professional billing. Per AMA CPT, modifier 27 is intended only for Hospital Outpatient (facility) coding. I don't know the MAC for your area but you can also reference the links below in regard to modifier 27.


Hope this helps!
 
keke74 said:
Hello Nikki,

You would only apply modifier 27 to the facility E/M level and modifier 25 on the Pro-fee E/M level. Modifier 27 does not apply to professional billing. Per AMA CPT, modifier 27 is intended only for Hospital Outpatient (facility) coding. I don't know the MAC for your area but you can also reference the links below in regard to modifier 27.


Hope this helps!
Click to expand...
Hello Keke74,

Thank you so much for your replay. That's what I thought--modifier 27 can be used on the 2nd Facility level visit charge only.
I would like to clarity modifier 25 on the Profee level charge. I thought that modifier 25 can be used on the Profee level when an ED Provider performed a procedure. I am still a little bit confused if we can use a modifier 25 on the 2nd Profee charge even if there is no performed procedure by an ED Provider. I tried to find guidelines regarding that topic; however, I couldn't find any.

thank you so much for any input, 🙂
Nikki
 
keke74 said:
Hello Nikki,

You can also add modifier 25 to each E/M code whenever more than one E/M service is billed on the same date of svc on the Pro-fee side per CPT guidelines. Please review the links below.



Hope this helps!
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Thank you so much keke74 for all the info and the links. This will help definitely.
thank you again 😃
 
Check your payer policies. Some want the times of the visits on the claim to differentiate in addition to Modifier 25 (pro fee claim). This is if it is the same provider. Also, some payers *might* want to roll them up into one if it is the same provider, but that is rare. In that case you would take both and combine it into one but that makes it really weird.

Example policy: Multiple emergency department visits provided by the same provider for the same client on the same day must have the times for each visit documented on the claim form. Also, more than one visit billed with the same date of service can be indicated by adding the appropriate modifier to the claim form. Medical documentation is required to support this service.
 
amyjph said:
Check your payer policies. Some want the times of the visits on the claim to differentiate in addition to Modifier 25 (pro fee claim). This is if it is the same provider. Also, some payers *might* want to roll them up into one if it is the same provider, but that is rare. In that case you would take both and combine it into one but that makes it really weird.

Example policy: Multiple emergency department visits provided by the same provider for the same client on the same day must have the times for each visit documented on the claim form. Also, more than one visit billed with the same date of service can be indicated by adding the appropriate modifier to the claim form. Medical documentation is required to support this service.
Click to expand...
Thank you so much Amyjph! :)
 
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