Physicians in the same group practice that are in the same specialty must submit claims and be paid as though they were a single physician. If more than one face-to-face evaluation and management (E/M) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one E/M service may be reported unless the E/M services are for unrelated problems. Instead of submitting separate claims and services, select a level of service representative of the combined visits and submit the appropriate code for that level.
If the reason for the second visit is an unrelated problem that could not have been addressed in the first encounter, the reason for a second visit must be clearly documented in the documentation field of the electronic claim or as an attachment to the CMS-1500 Claim Form.
Example: Identify when a provider is practicing in an unrecognized subspecialty (e.g., retinal specialist, hand surgery, etc.) and list the diagnosis code that is unrelated to the other E/M service for the same date.
Physicians in the same group practice but that are in different specialties may submit and be paid without regard to their membership in the same group. Refer to Centers for Medicare & Medicaid Services (CMS) Pub. 100-04, Chapter 12, Section 30.6.5 (PDF, 1 MB).