multiple services on same day for same-ish problem

OK...patient came to the office with nausea and vomiting. Doctor examined pt and suspected impaction in esophagus (pt has hx of this). Doctor sent patient to ER. A few hours later, doctor met patient in ER, did another H&P and then proceeded with an EGD with dilation and removal of foreign body. Since this elderly patient was already in a debilitated condition, doctor admitted for observation overnight.

I've identified four services here (office visit, ER visit, EGD (technically two codes for that) and hospital admission)...but I know insurance (Medicare replacement plan) won't want to pay for them all since they were all done on the same day. What is my best option?

E/m

E/M encounter will be Observation, based on level of medically necessary H&P- can consider E/M documentation in sites for OBS level. Also code the procedure. Modifier -25 on level of OBS code (99218-99220).

Same-ish

One E/M for the services, sorry.