Referal to a specialist in the same group practice on the same day of a E/M service

Is a modifier appropriate when a FP sends a patient to a specialist in the same group practice on the same day that the patient had a E/M visit.

Referral to a specialist in the same group practice on the same day as an E/M service

I don't think most payers will require a modifier if the physician specialties are different. The claims processing systems shouldn't edit it as a duplicate in that case. Having said that, I'm sure there are some that will, and that will require a 25 modifier on one of the claims.

Same or different diagnosis may make a difference, as well, in whether it denies first and you have to appeal with notes.