Modifier 24, 24 modifier

Modifier 24 Description, Uses, Guidelines & Examples (2022)

Modifier 24 appends with the service when unrelated Evaluation and Management service performs by the physician during the postoperative period.

Modifier 24 Description

Modifier 24 attaches to the service when the service renders in the postoperative period by the physician for unrelated Evaluation and management services. Therefore, it is irrelevant to add 24 with surgical procedure codes 10000-6000, and It is applicable with E/M visit codes only (99201-99499).

It only applies to Evaluation and management codes when an unrelated service performs compared to the original procedure.

Modifier 24 indicates the Evaluation and management service performed by the physician or a skilled professional during the postoperative period for an unrelated reason. For example, the patient had a surgical procedure on the right shoulder and may present with Knee pain in the postoperative period.

24 Modifier is only applicable when the patient had a visit during the postoperative period of the surgical procedure, Which has a 10 or 90 days global period. It is inappropriate to append on the day of the surgical procedure or after the global period.

Radiology, Laboratory, Medicines, and Anesthesia CPT codes doest not accept the 24. Using the global modifier for surgical such as 78, 79, 58, etc., is appropriate.

The insurance may or may not request evidence or proof that the service is unrelated. Therefore, you need to submit the appropriate documentation.

24 modifier

What Is Modifier 24?

Modifier 24 attaches to the service when the service renders in the postoperative period by the physician for unrelated Evaluation and management services. It only applies to Evaluation and management codes when an unrelated service performs compared to the original procedure.

When To Use Modifier 24

Modifier 24 applies when the physician performs unrelated Evaluation and management services during the global period of 10 or 90 days of surgical procedure.

Documentation should support the service performed by the physician is entirely unrelated to the condition of the prior surgical procedure, which has a 10 or 90 days global period.

The same physician may perform or oversee the immunosuppressant therapy during the 10 or 90 days global period of a prior surgical procedure such as a transplant. 

The same physician may perform or oversee the chemotherapy y during the 10 or 90 days global period of a prior surgical procedure such as tumor resection.

The same physician may perform the critical care services during the 10 or 90 days global period of a prior surgical procedure, such as complications unrelated to the original service.

The same physician may perform the procedure during a prior surgical procedure’s 10 or 90 days global period, such as distinct anatomical location. It may be the same but in a different anatomical site.

Modifier 24 Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

Modifier 24 only to Evaluation and Management service codes (99201-99499). It is inappropriate to add along with surgical procedures or other diagnostic and Medicines services. 

The physician may perform E/M service (99202-99499) for the complications related to the prior surgery, which has a 10 or 90 days global period. It is inappropriate to attach 24 Modifier with that service. It is only applicable when performed on unrelated conditions.

The physician may perform suture removal or wound infection of prior surgical procedure, which has a 10 or 90 days global period. Therefore, it is inappropriate to add modifier 24 because it includes in the global package.

The physician may order to admit the patient to a skilled nursing facility for a condition related to the prior surgical procedure. Therefore, it is inappropriate to add 24 because it includes in the global package.

The documentation identifies that the service is related to a surgical procedure within a 10 or 90 days global period; it is inappropriate to add modifier 24 because it includes it in the global package. Instead, it should support the service as an unrelated condition.

The physician may perform service out of 10 or 90 days globally. Therefore, adding 24 to that service is inappropriate because it is applicable only during the postoperative period.

The physician may perform the service on the same day as the surgical procedure. Therefore, adding modifier 24 to that service is inappropriate because it is applicable only during the postoperative period.

Modifier 24 vs 25

Modifier 24 applies with evaluation and management CPT codes (99201-99499) when the physician provides care for an unrelated condition in the postoperative period. Documentation should support the medical necessity of service unrelated to the surgery.

In contrast, Modifier 25 evaluates and manages CPT codes (99201-99499) when the same physician performs significant service and is separately identifiable on the same day to the same patient.

For Instance, Physicians saw the patient with acute chest pain in the morning, and the patient came back to the provider with shoulder pain on the same day in the evening and performed a procedure on the shoulder of the patient. In this case, It is appropriate to report modifier 25 with E/M Visit code 99202-99499.

Similarly, If the same physician provides the shoulder procedure, which has a 90 or 10-day global period, and the patient returns to the provider in the postoperative period for chest pain, It is appropriate to report an E/M visit 99201-99499 with 24 Modifier.

Modifier 24 and 79

Modifier 24 applies with evaluation and management CPT codes (99201-99499) when the physician provides care for an unrelated condition in the postoperative period. Documentation should support the medical necessity of service unrelated to the surgery.

In Contrast, Modifier 79 append with services unrelated to the procedure or service performed in the postoperative period. Therefore, it usually represents the unrelated procedure to the prior surgery during the 10 or 90 days global period.

For example, the physician performs a surgical procedure on the abdominal region, which has a 10 or 90 days global period. If the physician performs the E/M (99201-99499) visit in the postoperative period related to the heart, which is entirely unrelated to the prior procedure. It is appropriate to append 24 Modifier with CPT code 99201-99499.

Similarly, Suppose the same physician performs another service other than evaluation and management services, such as lesion removal of the head region, which is unrelated to the heart. In that case, Adding a modifier 79 with that service is appropriate. 

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 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 24 Modifier on the same day as a procedure.

Modifier 24 Examples

The following are the examples of when modifier 24 appends with the CPT codes:

Example 1

A 36-year-old male presents to the office for routine hypertension and Diabetes maintenance on April 4, 2022, and has KNEE ARTHROSCOPY/SURGERY on March 1, 2022. Suppose CPT codes 99214 and 29881 bills for these services. Then, according to 24 Modifier, KNEE ARTHROSCOPY, or SURGERY unrelated service performed by the same physician in the postoperative period, it is appropriate to report an E/M visit with 24.

Modifier 24 appends with CPT code 99284 to unbundle the service with CPT code 29881. Therefore, it may bill 99284 as the primary procedure code with modifiers 24 and 29881 as the secondary procedure code. 

If a different physician performs Knee arthroscopy surgery in the postoperative period, It is inappropriate to append 24 with CPT code 99214

Documentation must support the medical necessity of these two services on the same day for accurate reimbursement by the insurance or third-party payer.

Example 2

A 46-year-old male presents to the physician for an emergency department visit on December 2, 2022, with Abdominal pain and nausea with vomiting, and had a procedure for Inguinal hernia repair on January 23. Suppose CPT codes 49505 and 99284 bills for these services. Then, according to 24 Modifier, Inguinal hernia unrelated service performed by the same physician in the postoperative period, it is appropriate to report an E/M visit with 24.

Modifier 24 appends with CPT code 99284 to unbundle the service with CPT code 49505. It may bill 99284 as the primary procedure code with modifiers 24 and 49505 as the secondary procedure code. 

If the different physicians perform inguinal hernia repairs in the postoperative period, It is inappropriate to append 24 with CPT code 99284.

Documentation must support the medical necessity of these two services, such as inguinal hernia repair and emergency department visits on the same day for accurate reimbursement by the insurance or third-party payer.

Example 3

A 76-year-old male presents to the physician for – Combined right and left heart catheterization and had an ED visit for Angina Pectoris and Enterectomy by the same Physician 60 days ago. Suppose CPT codes 44120 and 99284 bills for these services.

Then, according to 24 Modifier, Enterectomy is an unrelated service performed by the same physician in the postoperative period, and it is appropriate to report a CPT code 99284 with 24.

If an Enrectomy procedure performs by a different physician in the postoperative period, It is inappropriate to append 24 with CPT code 99284.

Modifier 24 appends with CPT code 99284 to unbundle the service with CPT code 44120. Therefore, it may bill 99284 as the primary procedure code with modifiers 24 and 44120 as the secondary procedure code. 

Documentation must support the medical necessity of these two services, such as Emergency visits and Entrectomy on the same day, for accurate reimbursement by the insurance or third-party payer.

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