Modifier 27 Description, Examples, & Usage Guidelines

The medical billing specialists and certified professional coders (CPCs) at MediBillMD understand that healthcare facilities often strain their revenue cycle due to frequent claim denials caused by overusing and misusing modifiers. Thus, our experienced team decided to pen down a guide related to the modifier 27, which is exclusively for institutional billing.  

So, if you are a hospital aiming to achieve financial success by mitigating the risk of ‘incorrect modifier-related denials’, we recommend you read this guide till the end. 

Modifier 27 – Description

This modifier was exclusively introduced for institutional billing to report multiple hospital outpatient evaluation and management (E/M) encounters on the same day, even if with different providers. 

Simply put, the hospital outpatient department may report modifier 27 to the second or subsequent E/M service codes when multiple E/M services are rendered on the same day. It indicates to the payer that the E/M services are distinct and separate, even though performed for the same patient on the same service date.

Modifier 27 – Examples

Discussed below are some practical scenarios to help you understand the application of modifier 27:

Allergic Reaction Management and Medication Adjustment

Assume a scenario in which a cancer patient visits the outpatient infusion center for scheduled chemotherapy. However, soon after the infusion begins, the patient experiences an allergic reaction. As a result, an E/M service is rendered to address the reaction.

Moreover, once the reaction has subsided, a separate E/M service is provided on the same day to discuss chemotherapy medication adjustment because of its adverse effects. 

Hence, modifier 27 applies to the second E/M service, medication adjustment, as it is a distinct encounter from the initial reaction management.

Fall and Subsequent Headache Evaluation

Consider another example where an elderly patient visits the outpatient clinic for a routine follow-up. However, he trips and falls in the clinic during the visit and experiences a headache. Thus, the healthcare provider performs another E/M service to evaluate the headache, including a neurological exam. 

Here, modifier 27 will apply to the E/M code for headache evaluation because it is a distinct encounter from the previously scheduled follow-up visit.

Post-Surgery Wound Management and Back Pain Evaluation

What happens when a patient comes to an outpatient facility for scheduled wound care management after undergoing a surgical procedure but, during the check-up, complains about severe back pain? 

The clinic’s healthcare provider may conduct a focused examination to evaluate back pain. Thus, modifier 27 will be appended to the E/M code for the back pain assessment since it is a distinct E/M service from the scheduled wound care management service.

Accurate Usage Guidelines for Modifier 27

Looking at the scenarios can only give a glimpse of this modifier’s usage. However, there is more to ensuring the appropriate usage of modifier 27. Thus, in this section, we will discuss the rules related to its proper usage. So, without ado, let’s get right into the details:

Use for Institutional/Hospital Billing 

This modifier was exclusively introduced for hospital outpatient departments, such as critical care units, emergency departments, etc. That is, you can only use this modifier on the UB-04 Part A claim form or its electronic equivalent.

Do Not Append on CMS-1500 Claim Form 

You should not append modifier 27 while reporting multiple E/M services for physician practices, as this is out of its scope. That is, you cannot use this modifier on the CMS-1500 form or its electronic equivalent.

Append with Second E/M Service Code 

You should not append this modifier on the first E/M code. However, you must append it to the subsequent hospital outpatient E/M services rendered on the same day for the same patient.

Append with Specified CPT/HCPCS Codes 

As a hospital outpatient department, you may use the modifier 27 while billing multiple services from the following E/M code ranges:

• Critical care services from 99291-99292.
• Hospital type A emergency department visits from 99281-99285.
• Hospital type B emergency department visits from G0380-G0384.
• Hospital outpatient clinic visit for assessment and management service code G0463.
• Initial preventive physical examination code G0402.
• Ophthalmological E/M services from 92002-92014.
• Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present code G0175.

Use 27 with Condition Code G0 for Multiple Encounters

You may also use the modifier 27 to report condition code G0 when multiple medical encounters occur on the same service date in the same revenue center.

Modifier 27 vs. 82 – Understanding the Difference

Below is an at-a-glance table of modifier 27 vs. 82:

	Modifier 27	Modifier 82
Application	E/M services	Surgical procedures
Purpose	Identifies multiple E/M encounters on the same day.	Identifies services of an assistant surgeon.
Place of Service (POS)	Hospital outpatient department	Operating room

Modifier 27 indicates multiple hospital outpatient E/M services on the same service day. That is, a patient received more than one distinct, medically necessary evaluation and management service addressing different issues on the same day. For instance, a patient came to an emergency department for chest pain evaluation and later on the same day for abdominal pain evaluation. Thus, you should report the second E/M code with the modifier 27 to ensure rightful reimbursements. 

Conversely, modifier 82 highlights that you are reporting the services of an assistant surgeon during a surgical procedure. For example, a primary surgeon performs a laparoscopic cholecystectomy, and another surgeon assists the surgery. Hence, if you want to bill for the services of an assistant surgeon, you will append the surgical procedure code with modifier 82. 

Another key difference between these modifiers is that 27 is exclusively for institutional/hospital billing, while 82 is typically used in professional/physician billing.

Summary

With that said, let’s wrap up this guide on modifier 27! This modifier is used by healthcare institutions or hospitals to report multiple outpatient E/M services rendered to the same patient on the same service date. We shared some examples where this modifier may apply. These included allergic reaction management followed by medication adjustment, fall with subsequent headache management, and post-surgery wound care followed by back pain evaluation.

Moving forward, we shared the billing guidelines and explained how this modifier differs from modifier 82. However, if you still have questions, refer to the FAQs discussed below, as we may have answered your queries.

Frequently Asked Questions