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Modifier 25 and ER Visits

  1. Default Modifier 25 and ER Visits
    Medical Coding Books
    Can anyone point me to the regs for Medicare that govern the use of Modifier 25 with regard to ER visits? I have been out of the coding research business for awhile.

  2. #2
    Columbia, MO
    I am not sure what you are looking for. You need a 25 modifier for any visit ER included when a procedure is performed in the course of the encounter. The same is true for facility, except that facility has a minor twist, if a procedure is performed in any encounter for the day any visit ER or otherwise must have a 25 modifier to be reimbursed. Of course presuming the visit qualifies for a 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Do you always apply a modifier 25 with an ER E/M level when charging a 36415?

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