Pulmonology Coding Alert

Question:  If a patient is seen twice by two different physicians on the same date of service, can I report an E/M service code for the service performed by each of the physician or should I just report one E/M code?

North Carolina Subscriber

Answer: You are allowed to report more than one E/M code for a patient on the same date of service if the patient is seen by more than one physician of different specialties. However, you will be allowed to report two E/M codes for the same patient on the same date of service only if the patient sees the physicians for different complaints and not for the same problem, and the physicians are not in the same group practice.

In order to distinguish that the patient saw the two physicians for significant and separate problems, you will have to report the second E/M code with the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to the code.

Note: If the service occurred in the outpatient department of a hospital, the hospital claim will append the modifier 27 (Multiple outpatient hospital E/M encounters on the same date) instead of the modifier 25.

Coding tip: If both physicians are from same specialty or subspecialty and with same Tax ID number, then the services are billed as a cumulative service, in any one physician’s name.