tci ED Coding & Reimbursement Alert - 2007 Issue 11

Inherent or Separate? You Must Know Before Coding E/Ms With Modifier 25

Be ready to scour notes for proof of separate E/MAll medical coders need to know the rules for coding an E/M service with modifier 25--but in the ED, that knowledge is put to use almost every time a patient enters the doors of the facility.Remember, patients don't typically report to the ED at scheduled appointment times for preplanned procedures. Thus, you will often have to decide whether to include an E/M-25 on your procedure claims. Coder input: -When a patient comes into the ED, for whatever reason, the physician must first evaluate the patient. The chief complaint (CC)...

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