Cardiology Coding Alert

Question: One of our cardiologists was called for a consult on an inpatient. He in turn requested a consultation by our electrophysiologist on the same day. Should we expect to get paid for both consults, and should we use a modifier?

Pennsylvania Subscriber  
Answer: Two factors determine whether two E/M visits may be billed on the same day. First, do regulations in your state designate electrophysiology as a specialty separate from cardiology (most do not). Second, do the electrophysiologist and the cardiologist belong to the same practice and use the same tax identification number (TIN).
 
If electrophysiology is not categorized as an indepen-dent specialty and the two physicians belong to the same group using the same TIN, most carriers will pay for only one consult if one of them is critical care.
 
Although some payers may accept both consults if  modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is appended to the electrophysiology claim, most will not accept two consults from the same practice on the same day.