tci ED Coding & Reimbursement Alert - 2006 Issue 2

READER QUESTIONS: Evaluate Context for Modifier 25

Question: If a patient presents in the ED with a minor laceration and no other injuries, but the physician documents an H&P that meets the requirements for an E/M code, can we charge for both the E/M and the repair?New Jersey SubscriberAnswer: For you to report a separate E/M service, the service has to justify using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), which means it needs to be both separate and significant. The service you describe was clearly separate...

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