2 E&Ms provided by doctors of different specialty

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If Dr. A (one specialty) sees a patient for an E&M service and then Dr. B (same practice but completely different specialty) also sees the same patient for an E&M on the same DOS, does the second E&M require modifier -25?
 
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If Dr. A (one specialty) sees a patient for an E&M service and then Dr. B (same practice but completely different specialty) also sees the same patient for an E&M on the same DOS, does the second E&M require modifier -25?
Per Medicare Claims Processing Manual 30.6.5 - Physicians in Group Practice (Rev. 1, 10-01-03), "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group."

Based on this, you don't need to append modifier 25 for the service of Dr. B since they have different specialties.
 
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115
Location
Woodbridge, VA
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Per Medicare Claims Processing Manual 30.6.5 - Physicians in Group Practice (Rev. 1, 10-01-03), "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group."

Based on this, you don't need to append modifier 25 for the service of Dr. B since they have different specialties.
Thanks for the response and for indicating its source. That's always appreciated. So here is additional piece to my first scenario...Dr. A decides to do procedure and now Dr. A adds a -25 modifier to his E&M. Dr. B still wouldn't add a -25 to his E&M?
 
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Thanks for the response and for indicating its source. That's always appreciated. So here is additional piece to my first scenario...Dr. A decides to do procedure and now Dr. A adds a -25 modifier to his E&M. Dr. B still wouldn't add a -25 to his E&M?
Per definition, Mod 25 is a significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service.

Based on your scenario, Dr. A should append modifier 25 to his E/M service to indicate that it is distinct to the procedure done on the same day. As for Dr. B, you still won't need to append modifier 25 since he belongs to a different specialty.
 
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