Although the ET modifier appears simple in its description, a majority of medical billers still apply it incorrectly without even realizing it. One small mistake can disrupt your cash flow due to claim denials and payment delays.
In this blog, we will discuss everything related to this modifier. So, what is modifier ET exactly? What actual emergencies might this modifier be used for, and most crucially, where is it not applicable?
If all these questions are making you curious, then keep reading to find the answers.
ET Modifier – Description
The ET modifier is another important informational modifier applied to Healthcare Common Procedure Coding System (HCPCS) codes. It was introduced by the Centers for Medicare & Medicaid Services (CMS) to describe emergency room (ER) services effectively.
Basically, modifier ET indicates that a medical service was provided in an ER on a subsequent service date after the primary ER encounter. The abbreviation ET itself refers to an ‘emergency treatment’. It helps differentiate emergency department services from other hospital services when the ER stay prolongs to multiple days.
So, ET is applied to line items on claims when a patient receives emergency care due to a serious or life-threatening condition, usually in an ER or urgent care setting.
Note that these emergency services include dental procedures and laboratory tests.
Appropriate Use Case for ET Modifier
The following is a possible scenario where the ET modifier may be applicable.
Accidental Injury
A patient is brought to a hospital after a catastrophic vehicle accident with various injuries, including fractures, cuts, and possibly internal bleeding. The physician available in the emergency department performs imaging tests, such as CT scans and X-rays, and then carries out procedures for wound stabilization and repair over several days.
Here, the follow-up services, such as bone repairs, wound evaluation, and further radiology tests, will be billed using the appropriate emergency‑department evaluation and management or procedural codes, with the ET modifier appended (where required) to notify the payer that services were directly related to the initial catastrophic‑injury ER encounter and performed on subsequent service dates.
Accurate Usage Guidelines for ET Modifier
The following are some guidelines that you must remember when appending the modifier ET to your claims.
Ensure the Modifier’s Correct Use
The ET modifier is only applicable to services provided in a hospital emergency room and does not include care in a skilled nursing facility. Moreover, the emergency services must span multiple service days, and only the services performed on subsequent days after the initial ER encounter should be coded with modifier ET.
Include Complete Documentation
Before appending the ET modifier to the service codes on the claim, verify that the modifier matches the specific situation and the corresponding code. Confirm that the medical record clearly documents the emergency nature of the services, the length of the encounter, and the services performed. Clear documentation of the procedure and its justification is crucial for securing payment from payers.
Confirm Payer’s Billing Rules
The ET modifier is appended to certain codes for emergency services performed on a date after the date the patient entered the Emergency Room (ER). But some insurance payers set specific billing rules and do not accept this modifier for all emergency services.
For instance, some payers only accept ET for emergency dental treatments, while others allow you to append this modifier to specific ER codes. Therefore, before you file your claims, it is important to check the payer’s guidelines regarding the application of this modifier.
Understand the Dos and Don’ts
- Do not append to service codes that fall under Part A Skilled Nursing Facility (SNF) stay.
- Use it to bypass SNF Consolidated Billing.
- Append to codes 99070, 99218, 99281-99285, 99291, and 99292.
- Append every time the patient visits the ER, and the service extends to multiple days.
- Append the ET modifier to an emergency dental procedure code as well.
Final Thoughts
In this blog, we discussed comprehensive and up-to-date guidelines for the ET modifier. We have explained its usage with a real-life example and offered you a thorough guide to accurate and inaccurate uses of this modifier.
However, if you are still struggling to code your emergency services claims, consider opting for NeuraBill’s medical billing and coding services for professional assistance. Their coders are AAPC-certified and bring a wealth of industry knowledge and experience to the table.
