Results 1 to 5 of 5

ER Physician Billing

  1. Question ER Physician Billing
    Medical Coding Books
    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?
    Last edited by jacubillas; 12-06-2007 at 07:58 AM. Reason: Clarification

  2. #2
    do not understand your question....please rephrase your question

  3. #3
    Greater Portland (Maine)
    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.

  4. #4

    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!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  5. #5
    St. Louis, Missouri
    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.

    Melissa Blow, CPC

Similar Threads

  1. PA/Physician Billing
    By tfischer in forum EMR/EHR Systems
    Replies: 2
    Last Post: 04-14-2011, 04:34 AM
  2. Physician Billing for Physician - Help
    By aslonsky in forum Medicare Regulations
    Replies: 2
    Last Post: 03-12-2011, 06:21 PM
  3. Hospital Billing vs Physician Billing
    By CBC in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 05-19-2009, 02:14 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.