tci ED Coding & Reimbursement Alert - 2023 Issue Q2

Modifier Madness, Part 2: Get 25/57 Claims Right by Separating E/M

Billable E/M service might be obvious, but never assume it. When your ED provider performs a significant, separately identifiable evaluation and management (E/M) service in addition to a surgical procedure, you need modifier smarts to separate a codeable E/M from the E/M that is built into the relative value units (RVUs) of the surgery. Recap: In January, we discussed examples of when two distinct problems can and can’t justify the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure...

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