Jared Posted Tue 10th of January, 2012 23:25:54 PM
We bill for a hospital/clinic in bush Alaska. They have outpatient clinics in addition to a full service hospital. We had a patient come in to the clinic for e/m service at 14:05, then returned to the ER at 19:15 the same day. The insurance is denying the second visit as included in the 1st visit. The diagnosis was the same, but different places of service and different physicians. We applied modifier 27 to the ER visit. Is this the correct way to bill this?
SuperCoder Answered Wed 11th of January, 2012 13:38:38 PM
Yes, this is the correct way to bill and appropriate to append modifier-27 on ER visit code. This modifier is specifically used for separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date with different physicians.
Note: This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date. For physician reporting of all outpatient E/M services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital ED, clinic), you should refer E/M, Emergency Department, or Preventive Medicine Services codes.