Modifier 24 | Unrelated E/M Service During Postoperative Period

Modifier 24 can be used for an unrelated evaluation and management (E/M) service by the same physician or another qualified healthcare professional during a postoperative period. This modifier is appended to an E/M service when the provider renders an E/M during the patient’s global surgery period, but the E/M is unrelated to the patient’s surgery. Ensuring that the E/M service is unrelated to the previous procedure and that the patient’s documented diagnosis meets the necessary medical necessity for the visit is crucial.

1. What is modifier 24?

Modifier 24 indicates an unrelated evaluation and management (E/M) service by the same physician or another qualified healthcare professional during a postoperative period.

This modifier is appended to an E/M service when the provider renders an E/M during the patient’s global surgery period, but the E/M is unrelated to the patient’s surgery.

2. When to use the 24 modifier?

Modifier 24 should be used when a physician examines a patient within the 90-day global period of a major procedure but for a different problem.

In addition, the E/M service must meet specific criteria, including occurring during the postoperative period of another procedure, being unrelated to the previous procedure, being provided by the same physician who performed the previous procedure, and the patient’s diagnosis documented must meet medical necessity for the visit.

3. Description

The official definition of modifier 24 is an “unrelated evaluation and management service by the same physician or other qualified healthcare professional during a postoperative period.”

4. Examples

Examples of procedures that require modifier 24 include a patient who had major surgery and returns for an unrelated E/M service during the postoperative period, such as a patient who had a hip replacement and returns for a follow-up visit for a sinus infection.

Another example is a patient who had a colonoscopy and returns for an unrelated E/M service during the postoperative period, such as a patient who returns for a follow-up visit for a skin rash.

5. Documentation

Documentation requirements for using modifier 24 include the need for the E/M service to occur during the postoperative period of another procedure, the current E/M service being unrelated to the previous procedure, the same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M. The patient’s diagnosis documented must meet medical necessity for the visit.

6. Billing

To bill for modifier 24, the E/M service must meet the above criteria. When submitting the claim, the provider should append modifier 24 to the E/M code. The claim should also include the diagnosis code for the unrelated problem.

7. Common mistakes

Medical coders make common mistakes when using modifier 24, including using it when the E/M service is related to the previous procedure, not using it when the E/M service is unrelated to the previous procedure, and not documenting the patient’s diagnosis for the unrelated problem.

8. Other modifiers related to modifier 24

Other modifiers related to modifier 24 include modifier 25, which is used to indicate a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service, and modifier 57, which is used to indicate an E/M service that resulted in the decision to perform surgery.

9. Tips

When using modifier 24, ensure that the E/M service is unrelated to the previous procedure and that the patient’s documented diagnosis meets the medical necessary for the visit. Document the patient’s diagnosis for the unrelated problem and use the correct E/M code with the modifier.

10. Conclusion

Modifier 24 indicates an unrelated E/M service by the same physician or other qualified healthcare professional during a postoperative period. Use this modifier correctly to ensure that the E/M service meets the necessary criteria.