ER Physician Billing

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7
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My facility has an ED. Up until now, I've only been coding for the facility fee. We are going to start billing for the MD, as well. The ED E/M level is not always the same as the physician E/M level, from what I understand. Do I add Modifier 26 for the physican component in ED?
 
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129
Location
Greater Portland (Maine)
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I've been coding ED encounters for 5 years. A 26 modifier is not appropriate for the professional E/M. The place-of-service indicated on the claim form will make the adjustment necessary for the professional portion. Do append modifer 25, though, if the physician also performs a procedure.
 
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165
Location
San Diego
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Hi,

My understanding is that a -26 modifier is not to be used on e/m services. The "professional component" is built-in, if you will. If your doc's do a same day of service procedure, you would add either (-25) modifier for procedures that carry a 0-10 post-op/global days or a (-57) modifier for procedures that carry a 90+ post-op/global days.
Hope this helps!
 

mmelcam

Expert
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262
Location
St. Louis, Missouri
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You do not put a 26 modifier on the emergency room E&M code. The only modifiers that you would probably use would be a 25 or a 57 if the physician performed a procedure.
 
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