# ER visit with procedure



## cpccoder2008 (Jun 25, 2008)

i recently read a forum and someone asked if they should attach -25 to the ER visit when a procedure was performed, everyone has answered yes and that sounds correct to me for an office visit but i was always under the impression that those rules didn't apply to Emergency Room visits, i do the billing for ER and have never attached -25 when they perform a procedure and my claims are always paid, and i was never told anything different, i just wanted additional feed back on this situation or if anyone has an article that states i should be using -25 ??


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## dawndi67 (Jun 27, 2008)

traciecpc said:


> i recently read a forum and someone asked if they should attach -25 to the ER visit when a procedure was performed, everyone has answered yes and that sounds correct to me for an office visit but i was always under the impression that those rules didn't apply to Emergency Room visits, i do the billing for ER and have never attached -25 when they perform a procedure and my claims are always paid, and i was never told anything different, i just wanted additional feed back on this situation or if anyone has an article that states i should be using -25 ??



I also bill for the ER and always attach the modifier 25 to my claims with a procedure and they are also always paid. I am also curious which is the correct way of doing this. If anyone else has any input????


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## liny (Jun 27, 2008)

*ER*

hello i code for several different states I always put mod 25 on levels,  lac repairrs, FB removals,  minore procedures  Fracture care gets mod 57 unless there is additional Dx's


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## kandigrl79 (Jun 30, 2008)

Modifier 25 should be appended to the E&M  code when an additional procedure is performed.


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## flycliffyboo (Jun 30, 2008)

*Does Medicare pay for Boniva infusion therapy yet?*

I live in PA and BCBS just began paying for Boniva infusions.  After trying to navigate Medicare's website (wow!) for an hour, I turn to the people who really know-you guys!
Can anyone tell me if Medicare has started paying for these infusions yet?

Thanks,
Flycliffyboo


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## zaidaaquino (Jun 30, 2008)

I went to www.trailblazerhealth.com and found the following information under their Outpatient Services Manual/Part A page 148:
"Modifier 25 should be appended only to E/M service codes within the ranges of 92002-92014, _99201-99499 _and with HCPCS codes G0101 and G0175."  
Therefore, modifier -25 can be appended to Emergency Department services (99281-99285).  This same manual gives two ED examples where -25 was used on the E&M when also performing procedure(s).  Hope this information helps.

Zaida, CPC


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## cpccoder2008 (Jun 30, 2008)

i know that -25 has to be attached to E/M levels with procedures for an office visit, but an Emergency Visit isn't really an office visit, its defined as an emergency setting so you don't and won't know if a procedure is needed at the time of service, so my understanding of it is that you only attach -25 if the visit is infact seperate, and for an ER visit, nothing is ever planned the day before. We do the billing for the physician's at a large hospital. We have been billing this way for years and have never had a problem. I just came across a forum where someone stated the always attach -25 to the ER visits. I just wanted to get some feedback on others. Our medicare/medicaid auditors have never metioned anything on this subject. I will have to contact them to see where i can get "In writing" that you must attach -25 or you don't.


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## dmaec (Jun 30, 2008)

but traciecpc - the Emergency Department service has E/M level codes (just like regular out patient physician visits or inpatient visits) they're all E/M levels.  We always append modifier .25 if a procedure(s) are also carried out in the ER - I wasn't able to find the article zaidaaquino refers to, however - from what Zaida says, the ER E/M codes fall within the range for requiring a modifier .25 if other procedures are done.  maybe your facility is being paid but are they being reimbursed correctly?  (either too much or too little?) I'd use the .25 modifier.


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## zaidaaquino (Jun 30, 2008)

dmaec, you are correct in stating ER E/M codes fall within the range for requiring modifier 25.  When I went to trailblazer's website, I did a search under "emergency department."  The Outpatient Services Manual is the second option that you click on and then go to page 148.

traciepc, you indicated that for ER visits, _nothing is ever planned the day before_.  This is exactly why you should use -25 because then your ER E&M would be a significant, separately identifiable service.  These are Medicare guidelines.  Hope this helps.

Zaida


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## cpccoder2008 (Jun 30, 2008)

zaidaaquino said:


> dmaec, you are correct in stating ER E/M codes fall within the range for requiring modifier 25.  When I went to trailblazer's website, I did a search under "emergency department."  The Outpatient Services Manual is the second option that you click on and then go to page 148.
> 
> traciepc, you indicated that for ER visits, _nothing is ever planned the day before_.  This is exactly why you should use -25 because then your ER E&M would be a significant, separately identifiable service.  These are Medicare guidelines.  Hope this helps.
> 
> Zaida



ok i found the article but it's for Medicare Part A so do the same rules apply to part b ? since im only billing for the physician's would this still apply ? i will have to send a claim out with -25 and monitor it to make sure we are getting the correct reimbursment. I will keep yall updated.

thanks


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