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ER visit with procedure

cpccoder2008

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i recently read a forum and someone asked if they should attach -25 to the ER visit when a procedure was performed, everyone has answered yes and that sounds correct to me for an office visit but i was always under the impression that those rules didn't apply to Emergency Room visits, i do the billing for ER and have never attached -25 when they perform a procedure and my claims are always paid, and i was never told anything different, i just wanted additional feed back on this situation or if anyone has an article that states i should be using -25 ??
 

dawndi67

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Copiague, NY
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i recently read a forum and someone asked if they should attach -25 to the ER visit when a procedure was performed, everyone has answered yes and that sounds correct to me for an office visit but i was always under the impression that those rules didn't apply to Emergency Room visits, i do the billing for ER and have never attached -25 when they perform a procedure and my claims are always paid, and i was never told anything different, i just wanted additional feed back on this situation or if anyone has an article that states i should be using -25 ??
I also bill for the ER and always attach the modifier 25 to my claims with a procedure and they are also always paid. I am also curious which is the correct way of doing this. If anyone else has any input????
 

liny

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ER

hello i code for several different states I always put mod 25 on levels, lac repairrs, FB removals, minore procedures Fracture care gets mod 57 unless there is additional Dx's
 

flycliffyboo

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Does Medicare pay for Boniva infusion therapy yet?

I live in PA and BCBS just began paying for Boniva infusions. After trying to navigate Medicare's website (wow!) for an hour, I turn to the people who really know-you guys!
Can anyone tell me if Medicare has started paying for these infusions yet?

Thanks,
Flycliffyboo
 
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Woodbridge, VA
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I went to www.trailblazerhealth.com and found the following information under their Outpatient Services Manual/Part A page 148:
"Modifier 25 should be appended only to E/M service codes within the ranges of 92002-92014, 99201-99499 and with HCPCS codes G0101 and G0175."
Therefore, modifier -25 can be appended to Emergency Department services (99281-99285). This same manual gives two ED examples where -25 was used on the E&M when also performing procedure(s). Hope this information helps.

Zaida, CPC
 

cpccoder2008

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i know that -25 has to be attached to E/M levels with procedures for an office visit, but an Emergency Visit isn't really an office visit, its defined as an emergency setting so you don't and won't know if a procedure is needed at the time of service, so my understanding of it is that you only attach -25 if the visit is infact seperate, and for an ER visit, nothing is ever planned the day before. We do the billing for the physician's at a large hospital. We have been billing this way for years and have never had a problem. I just came across a forum where someone stated the always attach -25 to the ER visits. I just wanted to get some feedback on others. Our medicare/medicaid auditors have never metioned anything on this subject. I will have to contact them to see where i can get "In writing" that you must attach -25 or you don't.
 

dmaec

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but traciecpc - the Emergency Department service has E/M level codes (just like regular out patient physician visits or inpatient visits) they're all E/M levels. We always append modifier .25 if a procedure(s) are also carried out in the ER - I wasn't able to find the article zaidaaquino refers to, however - from what Zaida says, the ER E/M codes fall within the range for requiring a modifier .25 if other procedures are done. maybe your facility is being paid but are they being reimbursed correctly? (either too much or too little?) I'd use the .25 modifier.
 
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Woodbridge, VA
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dmaec, you are correct in stating ER E/M codes fall within the range for requiring modifier 25. When I went to trailblazer's website, I did a search under "emergency department." The Outpatient Services Manual is the second option that you click on and then go to page 148.

traciepc, you indicated that for ER visits, nothing is ever planned the day before. This is exactly why you should use -25 because then your ER E&M would be a significant, separately identifiable service. These are Medicare guidelines. Hope this helps.

Zaida
 

cpccoder2008

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arkansas
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dmaec, you are correct in stating ER E/M codes fall within the range for requiring modifier 25. When I went to trailblazer's website, I did a search under "emergency department." The Outpatient Services Manual is the second option that you click on and then go to page 148.

traciepc, you indicated that for ER visits, nothing is ever planned the day before. This is exactly why you should use -25 because then your ER E&M would be a significant, separately identifiable service. These are Medicare guidelines. Hope this helps.

Zaida
ok i found the article but it's for Medicare Part A so do the same rules apply to part b ? since im only billing for the physician's would this still apply ? i will have to send a claim out with -25 and monitor it to make sure we are getting the correct reimbursment. I will keep yall updated.

thanks
 
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