If a physician sees a patient in the morning and again in the afternoon for a new or worsened condition, do we report modifier 25 for the second visit?
No, modifier 25 is used to identify a significantly, separately identifiable evaluation and management (E/M) service performed by a physician on the same date as a procedure or other service. Highmark Medicare Services would not expect to see two E/M services reported on the same date on a routine basis. A second E/M service would be billed for rare circumstances only. If a second E/M service is required on the same date of service, the documentation should clearly provide evidence that the second E/M service occurred, the reason for the additional E/M service, and documentation of the medical necessity of the second E/M service. If a second E/M service is reported on the same date, the service could initially be denied. The denial can be appealed using the appeal guidelines available on the Appeals Center.
Related Questions
- When the collaborating physician sees a patient after the nurse practitioner and then bills, does the MD/DOs note suffice to say: seen and examined as above, agree with treatment plan as outlined?
- May an ambulance crew report to the hospital the patient’s condition and the treatment provided?
- What organisms should be quantitated in the final report to the physician and patient’s chart?
