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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