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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 08:58 AM. Reason: Clarification

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

  3. #3
    Location
    Greater Portland (Maine)
    Posts
    129
    Default
    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
    Default
    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!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  5. #5
    Location
    St. Louis, Missouri
    Posts
    262
    Default
    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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