Q&A: Is modifier -25 right for all emergencies?

November 21, 2008
Virginia Martin, CPC, CHBC

The author, president of Healthcare Consulting Associates of N.W. Ohio Inc., has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assi

The modifier -25 is not applicable to all emergency-type services performed in the office.

Q: I am a solo practitioner in a rural community, and we frequently see patients in emergency-type situations (laceration repairs, setting broken limbs, etc.). My billing person recently attended a seminar sponsored by our local hospital and was told we should be using the modifier –25 attached to an evaluation and management service for all emergency-type appointments. Is that advice correct?

A: An E/M service should be billed the same day as a procedure only when a separately identifiable service is performed. Otherwise, simply bill for the laceration, fracture care, etc. An example would be if an established patient with few health issues came in for repair of a laceration. The services rendered to the patient would be preparatory to repairing the laceration. If, however, it was an established patient with multiple health issues, some of which were exacerbated by a trauma, and those issues require devaluation or stabilization, then charging an E/M service and attaching the modifier –25 would be appropriate.

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