Does CPT code 99285 need a modifier?

Medicare requires that modifier –25 always be appended to the emergency department (ED)E/M code (99281-99285) when provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s).

Which code does the 25 modifier go on?

Modifier 25 can be used for outpatient, inpatient, and ambulatory surgery centers hospital outpatient use. Modifier 25 can be used in other situations such as with critical care codes and emergency department visits.

What does CPT code for 99285?

CPT code 99285 is the uppermost level of this series. 99285 CPT code – ED visit for the Evaluation and management of a patient, which requires these three components within the limitation imposed by the urgency of the patient’s clinical condition and mental status: A comprehensive history. A comprehensive examination.

Can 99283 and 99285 be billed together?

E&M codes 99284 and 99285 are not reimbursable together or more than once to the same provider, for the same recipient and date of service. Instead, providers should use code 99283 to bill for second and subsequent recipient visits on the same date of service.

When should I use 99285?

Per CPT definition, the codes 99281-99285 are for reporting evaluation and management services in the emergency department. An emergency department is defined as an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention.

Is 99285 An E&M code?

Emergency Department (ED) Evaluation and Management (E/M) codes are typically reported per day and do not differentiate between new or established patients. There are 5 levels of emergency department services represented by CPT codes 99281 – 99285.

Who can bill 99285?

The ED physician should bill an E/M code (ED visits, 99281-99285), while the orthopedist can bill either a visit from that same code range or an office or outpatient service code (99201-99215), depending on whether the orthopedist considers the patient new or established.

Who can Bill 99285?

What does a 25 modifier mean?

significant, separately identifiable evaluation and management
Modifier 25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service.