Health Information Management

Tip: Assign modifiers correctly for multiple E/M visits with procedures

APCs Insider, April 29, 2011

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In some cases, you may need to append more than one modifier to explain what happened with a particular patient on a particular day. Consider this example.

Steve, an established patient with chronic ­obstructive pulmonary disease (COPD), comes into the ED at 10 a.m. because he is having trouble breathing due to high humidity. Dr. Walsh sees Steve, performs a level two E/M service, and sends Steve home.

At 2:30 p.m., Steve returns to the ED because he is having trouble breathing again. Dr. Smith sees Steve, performs another level two E/M visit, and orders a nebulizer treatment.

The coder should report this case as follows:

  • 94640 for the nebulizer treatment
  • 99282-25 for the first level two ED E/M service
  • 99282-25-27 for the second level two ED E/M service

For Steve's case, you must append both modifiers -25 and -27 to the second visit code. Modifier -25 indicates that the E/M service was separately identifiable from the nebulizer treatment. Modifier -27 tells the payer that Steve did indeed visit the ED twice during the same day.

The tip is adapted from “Modifiers -25 and -27: Multiple E/M visits with procedures” in the April issue of Briefings on APCs.



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