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Wiki E/M with modifier

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Cynthia A

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Kachina Coders
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i code for a group of hospitialist. The patient was seen on the 17th for the e/m service on the same day there was a procdedure done by another doc in the same group which modifier would you use?
 
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Same specialty?

If they are different specialties no modifier is required or appropriate.

Laura, CPC, CEMC
 
If they are in the same specialty and you are billing on one 1500 then yes, if they are two different specialties and you are billing 2 1500s then no.
 
So one hospitialist sees the patient then later in the day another hospitialist comes in and does what procedure?

Laura, CPC, CEMC
 
I do not do the billing.

I am asking how you would code this visit

I have the 2 docs in the same group.

Doc A saw the patient in the morning

Doc B did a procdure

How would you code showing Doc B ?
 
There is a difference between being in the same group and being of the same specialty.

I have multiple specialists that belong to the same group. I can have a hospitalist see a patient in the AM then and CVT surgeon do a procedure the PM and there is no modifier required on the hospitalists visit. They are not seen as the same provider because they are different specialties.

I don't have any hospitalists that do procedures so I am not sure what you are dealing with. Not trying to be difficult, just trying to answer the right question.

Laura, CPC, CEMC
 
If the decision for surgery was made at that visit you would use either the 25 or 57 modifiers depending on the procedure. If the visit had nothing to do with the procedure at all then you would use a 24.

If the decision for surgery was made prior to this visit, this visit is most likely included in the global and not billable.

Having said all that I think this is probably incorrect because odds are they are not the same specialty and their billing would not affect each other.

I strongly suggest you find out what specialties they actually are. Even though you may not be the one filling out the claim form you can not properly code without knowing what you are dealing with specialty wise.

Just my opinion,

Laura, CPC, CEMC
 
I am sorry for all the confusion as it is starting with me. We code out patient but for inpatient so our coding is a bit different. We do not do a surgical global period for a central line. All of our Doc are under one ID number so therefore they are all in one. Same group same speciality.
 
Same group does NOT equal same specialty

Cynthia,

I don't want to further confuse you, but just because they are under the same Tax ID (i.e. the same group) does NOT mean they are of the same specialty.

I work for a major medical center. We have HUNDREDS of doctors, all with the same tax ID (i.e. the same group). But we have dozens of different specialties.

So if the hospitalist saw the patient in the morning, and the CV surgeon (different specialty) placed the central line in the afternoon no modifier would be needed for the hospitalist's services. Same group but DIFFERENT specialties, so they are NOT considered the same doctor.

If the intensivist saw the patient in the morning and a different intensivist placed a central line later the same day, then you would need a -25 modifier on the FIRST physician's E/M code. Same specialty so they ARE considered the same doctor.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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