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Wiki e/r cpt codes and modifiers

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dackerman

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Hi

We are billing emergency room facility charges for example with a cpt code of 99283. Our 1500 bill is also going out with a cpt 99283. Both are going to an Auto insurance company which is now denying for a duplicate and wants us to put a modifier 25 on the 1500. I disagree with this. If there was a ekg or an X/R we would put the modifier 25 on the 99283 on the UB. Please advise :confused:
 
Are you billing facility and professional charges? The facility charges should be on a UB04 with a rev code of 450 and the physician charges on a 1500. There is no duplication when billed this way and both should pay. There is no need for a modifier on either claim unless a procedure was also performed.
 
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