Wiki Modifier for two specialists seeing patient on same day

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Hello
two different specialists wouldn't require a modifier to distinguish between the two specialists seeing the same patient same day.
There different specialist.

hope this helps

Regards,
 
If by "two different specialists" you mean two clinicians of different specialties in the same group, no modifier is needed.
Example1: Patient sees cardiologist and GI in the same multispecialty group, no modifier needed.
If by "two different specialists" you mean two different clinicians in the same group, but the same specialty, you probably can't bill both, but there are situations where it's possible.
Example2: Patient sees ENT#1 for hearing loss. ENT#1 examines patient and determines patient may benefit from a surgical procedure, but doesn't perform those procedures. ENT#2 sees patient to discuss the surgical procedure and determine plan. The practice can only bill for 1 visit. Same group, same specialty, same problem - bill one visit.
Example3: Patient sees ORTHO#1 in the morning for L knee pain. Later in the day, patient trips and thinks they may have broken their R arm. Sees ORTHO#2 who determines R wrist sprain. Most carriers will follow Medicare guidelines that 2 outpatient visits for unrelated problems that could not have been provided at the same time are both payable.
If your situation is example3, AMA states to use -25.

References:
CMS reference that you may bill 2 visits for same specialty if unrelated problems 30.6.7 Section B
AMA reference if 2 unrelated problems, use modifier -25

PS - this is all assuming you are providing office/outpatient visits. If hospital inpatient visits, you must combine all the work and bill 1 visit if they are the same specialty.
 
csperoni said:
If by "two different specialists" you mean two clinicians of different specialties in the same group, no modifier is needed.
Example1: Patient sees cardiologist and GI in the same multispecialty group, no modifier needed.
If by "two different specialists" you mean two different clinicians in the same group, but the same specialty, you probably can't bill both, but there are situations where it's possible.
Example2: Patient sees ENT#1 for hearing loss. ENT#1 examines patient and determines patient may benefit from a surgical procedure, but doesn't perform those procedures. ENT#2 sees patient to discuss the surgical procedure and determine plan. The practice can only bill for 1 visit. Same group, same specialty, same problem - bill one visit.
Example3: Patient sees ORTHO#1 in the morning for L knee pain. Later in the day, patient trips and thinks they may have broken their R arm. Sees ORTHO#2 who determines R wrist sprain. Most carriers will follow Medicare guidelines that 2 outpatient visits for unrelated problems that could not have been provided at the same time are both payable.
If your situation is example3, AMA states to use -25.

References:
CMS reference that you may bill 2 visits for same specialty if unrelated problems 30.6.7 Section B
AMA reference if 2 unrelated problems, use modifier -25

PS - this is all assuming you are providing office/outpatient visits. If hospital inpatient visits, you must combine all the work and bill 1 visit if they are the same specialty.
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One physician was an internal medicine physician and one was a pyshciatrist. They are denying the psychiatrist visit.
 
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