as the patient accounting and HIM director at a small, critical access hospital, you review the denials and account issues that occur for both the facility and the providers for whom you bill. Two years ago, you were looking at emergency department (ED) provider claims that had procedures performed. In every case, an E/M level codde had been assigned in additionto the procedure, and all E/Ms had been assigned modifier 25, which enabled them to bypass the edit stating that without the modifier the E/M level would not be paid.