Seems that the modifier 25 has become a large heated topic where I work. I work for a large hospital on the Pro-fee side. We, as you know will have multiple providers seeing the same patients under a group NPI. The issue is when an Intensivist and Cardiologist see a patient for services other than surgery. The patient may or may not have had surgery during their stay and will have a different diagnosis.
Per the code definition for modifier 25
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Heath Care Professional on the Same Day of a Procedure or Other Service.
It is my understanding that when two providers of different specialties billing on the same day must have a different diagnosis, and if under the same group NPI would then need to append a modifier 25 to one of the claims. It's usually one gets paid the other denies needing a modifier to distinguish the two separate identifiable services.
Can anyone please shed some light on this situation?
Per the code definition for modifier 25
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Heath Care Professional on the Same Day of a Procedure or Other Service.
It is my understanding that when two providers of different specialties billing on the same day must have a different diagnosis, and if under the same group NPI would then need to append a modifier 25 to one of the claims. It's usually one gets paid the other denies needing a modifier to distinguish the two separate identifiable services.
Can anyone please shed some light on this situation?