tci ED Coding & Reimbursement Alert - 2001 Issue 9

Receive Proper Payment: Distinguish Between Using Modifier -25 for ED Facility Versus Professional Service

Although the advent of modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) for hospital billing in June 2000 promised greater reimbursement for emergency facilities, it also created confusion among ED coders. Because rules for modifier -25 in a facility setting (hospital services only) differ from those on the professional side (physician services only), the main challenge is knowing when to append it to an E/M service. CMS has released two new transmittals to clarify the issue.   Transmittal A-00-40, released July 20, 2001...

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