tci ED Coding & Reimbursement Alert - 2006 Issue 10

Solve the Riddle of 'Separate' Versus 'Inherent' E/M Before Appending Modifier 25

The physician always performs some type of E/M preprocedure, and not all are separately reportable While it is important for coders in all specialties to know the rules for reporting separate evaluation and management services along with procedures on the same claim, knowing these rules may be even more important for ED coders.When your ED physician performs an E/M service and then a procedure, and you can prove they are significant and separate, you can report the E/M using modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or...

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