Same Group Coding

Question:

If an Electrophysiologist performs a 90-day procedure and an Interventional Cardiologist in the same group sees the patient mostly for the reason for procedure, can he bill an EM, if yes, would a modifier be necessary?

Answer:

The Interventional Cardiologist can generally bill an E/M (Evaluation and Management) service during the 90-day global period of a procedure performed by the Electrophysiologist in the same group — but only if certain conditions are met and modifier 24 is applied correctly.

Since both physicians are in the same group, they're typically considered the same provider for billing purposes. The key is demonstrating that the Interventional Cardiologist's service was separate, medically necessary, and not just a routine post-procedural visit that would normally be included in the global surgical package.

The documentation should clearly support why this additional E/M service was necessary and distinct from the typical care associated with the procedure.

*This response is based on the best information available as of 7/03/25.