Modifier 24 Fact Sheet
- Unrelated evaluation and management (E/M) service by the same physician* during a postoperative period
- Append modifier 24 to the E/M procedure code.
- Use on an unrelated E/M service beginning the day after a procedure, when the E/M is performed by the same physician* during the 10 or 90 day post-operative period.
- Use modifier 24 on the E/M if documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.
- Use modifier 24 on the E/M code when the same physician* is managing immunosuppressant therapy during the post-operative period of a transplant.
- Use modifier 24 on the E/M code when the same physician* is managing chemotherapy during the post-operative period of a procedure.
- When the same physician* provides unrelated critical care during the post-operative period.
- Do not use when the E/M is for a surgical complication or injection. This treatment is part of the surgery package.
- To document treatment of a wound infection, consider this part of the post-operative care.
- Do not use when the surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
- Do not use when medical record documentation does not clearly indicate the E/M was unrelated to the surgery.
- Do not use outside of the post-op period of a procedure.
- Do not use on the same day as a procedure.
Note: We determine payment based on the correct use of the modifier and any diagnosis on the claim. If a provider indicates they have additional documentation, we may develop for medical records. If we do not receive a response, we will deny the service. If we receive a response, we will pay or deny based on the medical records.
*Same physician – Medicare regulation states: "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician."
The patient presented a complaint unrelated to the surgery and the visit falls within the global period of the surgery.
Procedure code 72010 is not an E/M code; do not bill the X-ray with modifier 24 even though it is not relate to the surgery
Situations occur when it is necessary to report multiple surgery modifiers are reported on the claim.
The following is an example of appropriate reporting of both modifiers 24 (Unrelated E/M by the same physician during a postoperative period), and 25 (Significant, separately identifiable E/M by the same physician on the same day of the procedure or other service), on the same E/M code.
A physician performs a major surgery and within the global period sees the patient for an unrelated E/M visit. During this unrelated E/M visit, the physician determines the necessity of a minor surgery or other procedure. This minor surgery/other procedure is significant and separately identifiable from the E/M and unrelated to the original major surgery. Both the 24 and 25 modifiers are appropriate to add to the E/M code. The 24 modifier is appropriate because the E/M service is unrelated and during the postoperative period of the major surgery. The 25 modifier is necessary to identify that the minor surgery/procedure performed on the same day is separately identifiable from the E/M service. In addition, the minor surgery procedure code may need a 79 modifier to indicate the procedure is not related to the major surgery.
Page Last Updated: Wednesday, 17-Apr-2013 15:04:22 CDT