rmyohn
New
Having some issues in regards to when to use and not to use Modifier 25 on the professional charges within the Emergency Department. Currently, if the provider does anything over and above a physical exam (i.e, reading of EKG completed by another physician within the department; laceration repairs; POC US; etc.), we have been adding the 25 modifier to the professional charge. We are now being told by our auditing team, that we are doing this inappropriately. We are being told that unless there is some other dx code associated with the ED visit, we cannot add the modifier.....and in some cases, should not even be adding the E/M code for the visit. For example, if a patient comes in for a laceration repair and no testing or lab work is completed, the laceration repair should be the only thing billed with no E/M level. I understand this from a department that has scheduled appointments, but would this still apply to the Emergency Department when the providers have no idea what the patient is coming in for until they get in the room?? I feel like billing the professional charges for Emergency Providers is different than billing professional charges for Family Medicine or other specialty providers. Any insight is greatly appreciated. Thank you