Wiki Specialist/Subspecialist on the same day

[Cindyrev67]

If a patient sees our spine surgeon for an initial office visit or follow up visit and then sends the same patient to our pain management physician for an injection on the same day, how would I bill for that? Can I report two e/m codes on the same day. If not, would I append modifier 25 to the spine surgeon's office visit and a separate claim for the injection from the pain management physician?

Hope this makes sense

 

[scooter1]

It is my understanding that you cannot bill E & M for two visits from two physicians of the same specialty on the same day. The exception being if one was a hand specialist.

 

[josephmglick]

Most insurance companies will not pay for 2 office visits on the same day for the same group. We usually give the office visit to the spine/other Dr with a 25 modifier and let the pain Dr have the injection/procedure.

 

[aaron.lucas]

actually the 2012 guidelines go as far as subspecialty, so theoretically yes you could, but from what you're saying it doesn't sound like the PM doc is performing an E/M. Don't forget that a basic history and exam is built into the injection code. You shouldn't need a -25 for the surgeon's visit because they are not performing any other services, just the office visit, and -25 should only be used when other services are being performed by the same physician on the same day.