When either the personal physician or ED physician admits and continues care on the admission, may an ED visit code be reported separately with modifier 25?

When either the personal physician or ED physician admits and continues care on the admission, may an ED visit code be reported separately with modifier 25?

• A. Yes, ED visit can be reported with modifier 25
• B. No, cannot report separately
• C. Only if the patient is discharged
• D. Only if the ED is consulted

Answer: (A)

Modifier 25 signals a significant, separately identifiable E/M service by the same physician on the day of another procedure or service. In this context, the ED visit can be billed separately if the ED evaluation represents a distinct service from the admission itself. When the ED physician evaluates the patient in the ED and then the patient is admitted with ongoing care, the ED encounter is considered a separate E/M service that stands apart from the inpatient admission. If the documentation shows it was a separate evaluation and management service, you may code the ED visit with its E/M code (for example, an ED level) and append modifier 25 to indicate that it is separate from the admission service. This is why the best answer is that it can be reported separately with modifier 25.

Modifier 25 signals a significant, separately identifiable E/M service by the same physician on the day of another procedure or service. In this context, the ED visit can be billed separately if the ED evaluation represents a distinct service from the admission itself. When the ED physician evaluates the patient in the ED and then the patient is admitted with ongoing care, the ED encounter is considered a separate E/M service that stands apart from the inpatient admission. If the documentation shows it was a separate evaluation and management service, you may code the ED visit with its E/M code (for example, an ED level) and append modifier 25 to indicate that it is separate from the admission service. This is why the best answer is that it can be reported separately with modifier 25.