Wiki Two E/M Services, Same Day at Same Clinic, But Two Providers? What modifier??

[jessreese]

Hello! So I work for a clinic, where we have a bunch of different providers who do different things, but they are all under E/M codes. So I just ran into something that I have never seen before. I was entering a 99215 encounter for a provider, and I saw that our EMR system automatically put it on hold because there was a 99214 billed the same day but for a different provider. I cannot use -25 since it is a different provider, and I cannot use -59 since it cannot be attached to an E/M code. I read through every modifier and none will work. In this situation, does the E/M code need a modifier? And if so, which one should I use??
Thank you!!

 

[Cynthia Hughes]

Two E/M Services

If the physicians are enrolled with the payers in distinct sub-specialties (eg, family medicine, cardiology), no modifier is required. However, modifier 25 may be required if the payer doesn't recognize the distinction between sub-specialties (eg,internal medicine, obesity specialist) and the patient is seen by each physician for different complaints/diagnoses.

You may need technical assistance to determine why your system is not recognizing distinct sub-specialties.

Hope this is helpful.
Cindy