December 19, 2019
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?
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.