Modifier 24, 24 modifier

(2022) Modifier 24 – Description & Billing Guidelines (Unrelated E/M Service During Postoperative Period)

Modifier 24 allows the physician to report a service performed during a postoperative period for reason(s) unrelated to the original procedure. Underneath the billing guidelines for the 24 modifier.

How To Use The 24 Modifier

Append modifier 24 to the E/M procedure code or eye exam.

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 the 24 modifier 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 the 24 modifier 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.

Inappropriate Usage Of Modifier 24

Do not use modifier 24 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 the 24 modifier when the surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.

Do not use modifier 24 when medical record documentation does not clearly indicate the E/M was unrelated to the surgery.

Do not use this modifier outside of the post-op period of a procedure.

Do not report modifier 24 on the same day as a procedure.

Please Note

According to Medicare regulation ‘same physician’ means “Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.”

Assigning Both Modifier 24 And 25

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 modifier 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.

Modifier 24 and modifier 25 are both 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.

Please note: Modifier 24 should be assigned as Primary and Modifier 25 as secondary.

Return to List of all Modifiers

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