Modifier 24, 24 modifier

Modifier 24 | Description, Billing Guidelines & Example

Modifier 24 can be appended when a health provider performs an additional unrelated E/M service during surgery. Below are the description and billing guidelines for this modifier.

What Is Modifier 24?

Report modifier 24 only if the E/M service meets the following criteria:

  • The patient’s diagnosis documented must meet the medical necessity for the visit.
  • The current E/M service is unrelated to the previous procedure.
  • The E/M service occurs during the postoperative period of another procedural code.
  • The same physician (tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Description

Modifier 24 is officially described by the CPTs manual as: “Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period.”

Billing Guidelines

Sometimes a physician examines a patient within the 90–day global period of a significant procedure but for a different problem. 

When the patient has an E/M service with the provider for a postoperative visit, and the provider uncovers another unrelated problem during the visit, you can assign the no–charge CPT code 99024 for the postoperative visit and an E/M code with modifier 24 for the unrelated problem.

CPT 92002 to CPT 92014 (General ophthalmological services) are E/M services. Modifier 24 can be used for these services when applicable.

Example

A physician operated on the patient’s anus. Then, a month later, she sees the patient for a stomach problem. 

Bill modifier 24 in this case. 


Go back to the complete list of CPT modifiers.


Resources

https://www.aapc.com/blog/43274-unrelated-evaluation-and-management/

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52767

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/GloballSurgery-ICN907166.pdf

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