Basics about modifier -27 and 25

Many times, we get multiple visit cases of same day for same patient in Emergency Department. In such scenarios, we have to use modifiers to avoid them as duplicate claims. I have already posted previously how and which modifiers are used in medical coding. We already know the most common modifier used for E&M (Evaluation and Management) is modifier 25 and 27. Knowledge of Modifiers are important for Clearing CPC exams. However, when there are multiple visits we have to use one more modifier along with E&M level codes 99281-99285. Use of modifiers should be perfect from E&M to Surgery CPT codes.The multiple visits on same day are only being paid when we properly use the modifiers. Therefore, let us checkout the modifiers used with E&M level codes 99281-99285 for Emergency department multiple visits.

Become Expert in Using Modifier 25 & 27

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Check for S and T indicators for 25 modifier

The S and T indicators present with any procedure done with E&M level code, helps in adding modifier 25 with 99281-99285 CPT codes. Modifier 25 is appended with E&M codes, only when the same physician performs a separate procedure on the same day. Mostly the X rays, CT without contrast, Labs, IV infusion, injection are the common procedures done with E&M codes. The present of S & T indicators plays an important role in using modifier 25 with E&M level codes.

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Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service)

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Use 27 modifier for multiple visits

There can be multiple visits by the same patient to ED department. In such scenarios, we have to use modifier 27 with the second visit. This modifier is used only for outpatient hospital settings like Emergency department, clinic etc. We can use modifier 25 and 27 together, so do not get confuse with both these modifier. Both modifiers are defined separately and so use them correctly with E&M codes.

Use modifier -27 for multiple outpatient hospital evaluation and management (E/M) encounters on the same date. Use this modifier when a patient receives multiple E/M services performed by the same or different physicians in multiple outpatient hospital settings (e.g., emergency department, clinic, etc.)

Condition code ‘G0’ while using Modifier 27

The condition code G0 is used only for Hospital Outpatient Prospective Payment System (OPPS). The Condition code G0 indicates the multiple visits on same day as distinct and independent for each other and hence qualifies for the separate reimbursement for each visit. Modifier 27 will be use appropriately with E&M codes for multiple visits. 

Hope, now medical coder will be able to the live or example charts of E&M facility with correct use of these modifiers. Do share you thoughts about -25 and -27 modifier in the comment section below.