December 19, 2019
Question:
We have an osteoporosis clinic where our providers see patients on referral. Many times this referral comes from our own colleagues after the patient is seen through the ED for a fracture. A consult and global fracture care is billed in the ED by the first provider, and the referral is made to this clinic. All providers fall under the same group TIN/NPI. May we report an E/M-24 CPT code for this evaluation service?
Answer:
Yes, as long as medical necessity is present for the evaluation and/or screening, the E/M service is separately reportable. Append modifier 24 if the provider performing the service is in the same specialty as the provider who treated the patient in the ED; typically modifier 24 is not required if the provider is a different specialty, even within the same group practice.
*This response is based on the best information available as of 12/19/19.
