There seems to be a lot of ambiguity in defining separately identifiable E/M services. We have scenarios where patients were referred to different specialtists (Cardiology, ENT, GI, etc) who come and evaluate the patient. They eventually decide that the pt will have to undergo a procedure (Heart Cath, mandibular sx, EGd, etc) which happened to be completed on same DOS. We would add the appropriate -25 or -57 modifier. These used to be paid but recently we've been getting denials for the E/M, even with appropriate modifier appended. I guess my question is how do you really determine that the E/M is separately reportable when the provider would have to see the pt for the consult before they can decide if certain procedures are clinically indicated or not.