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Thread: ER Physician Billing

  1. #1

    Question ER Physician Billing

    AAPC: Back to School
    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
    Join Date
    Apr 2007


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

  3. #3
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    San Diego



    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
    Join Date
    Apr 2007
    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

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