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Help Er & observation Charge

  1. Red face Help Er & observation Charge
    Medical Coding Books
    Hello,

    I am trying to bill a claim to Medicaid and I am getting an edit that is stating they want a modifier on the observation code - cpt code 99218 because there is a conflict with cpt code 90935 tc Hemodialysis. There is also an ER visit involved that I already have a modifier 25 on.

    Can anyone help as to what modifier to use with the conflict of 99218 and 90935tc????


    I have not come across this before.

    Thanks Linda

  2. #2
    Location
    Daytona Beach, FL
    Posts
    752
    Default
    Quote Originally Posted by naplesl View Post
    Hello,

    I am trying to bill a claim to Medicaid and I am getting an edit that is stating they want a modifier on the observation code - cpt code 99218 because there is a conflict with cpt code 90935 tc Hemodialysis. There is also an ER visit involved that I already have a modifier 25 on.

    Can anyone help as to what modifier to use with the conflict of 99218 and 90935tc????


    I have not come across this before.

    Thanks Linda

    Hi Linda,

    Are you trying to bill the Observation on the same day as the ER visit by the same provider? You would use the 25 modifier on the Observation code for any separately identifiable services unrelated to the dialysis which cannot be done during the dialysis, but if the patient was seen in the ER and then admitted to Observation, the services provided in the ER would be included in the Observation charges and are not billed separately - if it is the same provider.

    Hope this helps.
    Jodi Dibble, CPC

  3. #3
    Default
    I agree with Jodie. You can't bill both an ER and an OBS charge by the same provider on the same day. remove the ER E&M and put the -25 on the OBS E&M.

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