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ED Coding and Reimbursement Alert

Documentation:

Prove Service's Separate Nature Before Coding E/M-25

Published on Wed Jun 22, 2011

Modifier 25 used most often on separate ED E/Ms.When your ED physician performs a procedure, a separate E/M service is common.Red flag: A separate E/M is not a given, even in the ED. If your ED physician performs an E/M service and a procedure on the same patient during the same encounter, you might be able to report the E/M using modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).The key: You must prove that the E/M is a separate service and is not a built-in component of the procedure. Remember two things to determine when to report an E/M with modifier 25, and when to leave the E/M off the claim.Uncover E/M Evidence in Notes"Coders should use modifier 25 when a significant, separately identifiable E/M service is performed by the same physician at the same face-to-face encounter [...]
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