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.
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