tci ED Coding & Reimbursement Alert - 2006 Issue 7

Prove Separate HEM For Proper Modifier 25 Claims

Certain E/M services are built in to procedure codes When a patient reports to the ED for treatment of a specific injury or illness, the physician usually performs some evaluation and management service along with the procedure. Issues: What E/M services are bundled into the procedure code, and how can you tell whether an encounter involved enough service to report a separate E/M?  If you can't answer these questions, you won't know whether it is possible to report a separate E/M with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the...

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