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Tips To Avoid Confusing Modifier -27 With Modifier -25

It has been a long time coming, but CMS has finally set a date to implement modifier -27 (multiple outpatient hospital evaluation and management encounters on the same date). It becomes effective Oct. 1, 2001. This modifier will make it easier for hospitals to demonstrate that billing for two outpatient visits by the same patient on the same day is not an error or an attempt to double-bill Medicare, but a valid claim.
 
However, CMS has ruled that modifier -27 will not replace condition code G0. Code G0 must still be used for multiple medical visits that occur on the same day in the same revenue centers.
 
In Transmittal A-01-80 dated June 29, 2001, CMS set out general guidelines for the use of modifier -27:
 

Modifier -27 should be appended only to E/M service codes within the range 92002-92014 (general ophthalmological services), 99201-99499 (E/M services provided in the physician's office or in an outpatient or other ambulatory facility), and with HCPCS codes G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) and G0175 (scheduled interdisciplinary team conference with patient present);
 

Hospitals may append modifier -27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the service is a "separate and distinct E/M encounter" from the service previously provided that same day in the same or different hospital outpatient setting; and
 

When reporting modifier -27, report with condition code G0 when multiple medical visits occur on the same day in the same revenue centers.
 
"Modifier -27 should be used when there has been a second E/M visit to a facility on the same day. It tells CMS, this is not a mistake, this is not a repeat of the same E/M code," explains Carol Dodd, RHIT, a senior coding consultant with MedQuist of Gibbsboro, N.J. "For example, if a patient comes to the ED (revenue center 450) with tachycardia, the physician may have the nursing staff make an appointment for the patient to visit the cardiology clinic (revenue center 480) on the same day. Then you would have two E/M codes going to CMS for the same patient on the same day, one for the ED (99284) and one for the cardiac clinic (99204-27). By adding the modifier -27, you are saying, 'We know these are different visits.'"

Condition Code G0
 
Condition code G0 specifies that multiple medical visits occurred on the same day with the same revenue center, and these visits were distinct and independent visits, according to PM A-00-21. "Under CMS rules for modifier -27, if a patient comes in to the same cost center twice on the same day [...]

- Published on 2001-09-01