Primary Care Coding Alert

Question: If a patient is seen twice by two different physicians on the same date of service, can I report an E/M service code for the service performed by each of the physician or should I just report one E/M code?

North Carolina Subscriber

Answer: You are allowed to report more than one E/M code for a patient on the same date of service if the patient is seen by more than one physician. However, you will be allowed to report two E/M codes for the same patient on the same date of service only if the patient sees the physicians for different complaints and not for the same problem.

In order to distinguish that the patient saw the two physicians for significant and separate problems, you will have to report the second E/M code with the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to the code.

As the descriptor to modifier 25 mentions the terms “same physician,” you can report two E/M codes for the same patient when seen by the same physician for two different problems.

Note: If the service occurred in the outpatient department of a hospital, you can also consider appending the modifier 27 (Multipleoutpatient hospital E/M encounters on the same date) instead of the modifier 25.

Coding Tip: If both physicians are from same specialty or subspecialty and with same Tax ID number, then only one service is billed, in any one physician’s name. q