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Facility Levels with Modifier 25

  1. #1
    Location
    Swainsboro/Statesboro
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    673
    Default Facility Levels with Modifier 25
    Medical Coding Books
    I was asked this question this morning about using modifier 25 on the facility E/M ER levels.


    If the nursing staff for the facility coding say does an injection would the modifier 25 be included on the E/M level???

    I am wondering since the facility E/M levels are charge master driven, is it included in that???

    Maybe I am having a blonde moment and too many debates this morning!!

    Thanks, Susan
    Susan Edwards, CPC, CEDC, AAPC Fellow
    Swainsboro/Statesboro Georgia President

    smecoder@gmail.com

  2. #2
    Location
    Columbia, MO
    Posts
    12,843
    Default
    In the facility you must use the 25 on the E&M with procedure with a status S or T indicator. In the past injection admin did not have a status of S or T but this could have changed. I know that our 3M encoder would should the status indicator for each CPT code as log as you had it set to APC not DRG.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Swainsboro/Statesboro
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    Ok... so that would be on the charge master side of the level.... so is it natural for the setting for the ER to be APC?
    Susan Edwards, CPC, CEDC, AAPC Fellow
    Swainsboro/Statesboro Georgia President

    smecoder@gmail.com

  4. #4
    Location
    Columbia, MO
    Posts
    12,843
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    yes the ER is an outpatient setting so all OPPS rules apply for APCs. The chargemaster might have the 25 imbeded but I am betting that it will have to be hardcoded by the coding department. We had a really hard time with this as the nurses were the ones originally that selected the E&M with a charge code which then went to the chargemaster, but they had 2 different charge codes, one that included the 25 modifier and one that did not, it did not take long to realize that this was not a good system and within a few months the coders were responsible for all modifiers which meant revamping the entire system so that we could "see" the codes generated via the chargemaster. This was quite the task but it did get done. Then after a few more months it became clear that the persons entering the charge codes were entering the incorrect ones and thereby pulling the incorrect codes so the system was again changed so that the coders could correct all codes that had been driven by the chargemaster and get all the correct modifiers for initial submission. Once this was done, there was a significant drop in rejected claims.
    Probably more answer than you wanted or needed, if so I apologize!

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Swainsboro/Statesboro
    Posts
    673
    Default
    No... I love the information, any and all is great. I feel that is where we are at a vamping or changing point in our facility charging sheet. We are using the T system and - yes we are still paper.
    Susan Edwards, CPC, CEDC, AAPC Fellow
    Swainsboro/Statesboro Georgia President

    smecoder@gmail.com

  6. #6
    Location
    Columbia, MO
    Posts
    12,843
    Default
    we found a point system was much easier than the T sheets. I may still have a copy laying around I will look and see.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Swainsboro/Statesboro
    Posts
    673
    Default
    Thank you Debra for your help.... some days it is worse to figure out than others!! LOL.
    Susan Edwards, CPC, CEDC, AAPC Fellow
    Swainsboro/Statesboro Georgia President

    smecoder@gmail.com

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