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.
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
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.