clarkmegan
Networker
If provider makes a decision for a same day procedure to be performed by a another provider in the same practice, same subspecialty, ie; same tax id, is it appropriate to append -25 to the E/M service?
Billing E/M for members of a group and same specialty are treated as if they were performed by a single provider for billing purposes.
In your case, modifier 25 would be appropriate to use, as long as the E/M were separately identifiable and unrelated to the decision to perform the procedure by the other provider.
Per NCCI edits...
If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers have separate edits. Neither the NCCI nor Carriers have all possible edits based on these principles.
Even if it's a group practice for member of the same specialty, this rule still applies.
In other words, make sure you aren't trying to skirt the "E/M that leads to decision to perform minor procedure is included in the procedure rule", by splitting it up between 2 providers. The E/M still has to be separately identifiable and unrelated to the decision to perform the procedure"