When to use Modifier 25 and Modifier 27


CPT code for E&M service from 99281 to 99285 is used for Emergency department. These codes when are coded with any diagnostic or therapeutic procedure, should be billed with modifier. Modifier 25 modifier is the most common modifier used with CPT code 99281-99285. The conjunction procedures like X rays, CT, lab tests, EKG or IV infusions help in determining the level of the service. Therefore, to get all these procedures paid the E&M modifiers are used. Modifier 27 is also one the modifiers used with E&M codes. This modifier is used for the multiple visits on same day for an E&M service. Let us check more about modifier 25, modifier 27 and the status modifiers.



When to use Modifier 25 and Modifier 27
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When to Use of modifier 25 and modifier 27



Modifier 25 should only be used when a conjunction procedure has ‘S’ or ‘T’ indicator along with significantly identifiable E&M service. Mostly X ray, CT without contrast, IV infusion, injection, IM (intramuscular) is very common with E&M codes. So, procedures with ‘S’ or ‘T’ status indicator along with E&M service, modifier 25 should be appended with E&M CPT code.
Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) 

When to use modifier 27


Modifier 27 is used when a patient has multiple visits on same day, by same or different physician for an E&M service. The documentation should be supported to code Modifier 27. If a patient comes with ED physician in morning and again visit the same or different physician in afternoon, the next E&M visit code will be appended with modifier 27. Do use modifier 25 also if any conjunction procedure is performed with status modifier ‘S’ or ‘T”. We can use both modifier 25 and modifier 27 together.
Use modifier -27 for multiple outpatient hospital evaluation and management (E/M) encounters on the same date. Use this modifier when a patient receives multiple E/M services performed by the same or different physicians in multiple outpatient hospital settings (e.g., emergency department, clinic, etc.)

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