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2 E/M same day-different docs

  1. #1
    Default 2 E/M same day-different docs
    Medical Coding Books
    Our general cardiologist saw a patient today and then requested a consultation from our peripheral vascular/interventionalist cardiologist on the same day. I can see this as being possible if the interventionalist is listed under a separate taxonomy code but what modifier would I attach to the second E/M encounter? The 25 modifier says "same physician." Btw, this is a commercial insurance patient.

  2. #2
    Are the two cardiologists listed under different tax codes or accredited as different subspecialties? There really isn't a modifier that can be applied for this purpose. If they have different tax numbers you would not need a modifier on the second E/M encounter.

    Even if they are both under the same specialty/tax number you should still be able to, provided that it really was necessary for the interventionalist to see the patient. There is also the option of using a 57 modifier, provided the interventional cardiologist decides during the consult that there needs to be an intervention performed. This is a tricky situation, the worst that can happen is the consult is denied and you get paid nothing, which is what you'd get if you didn't bill anything at all
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

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