Modifier 24

Unrelated Evaluation and Management (E/M) service performed by the same physician during the postoperative period

Correct Use

  • Can be used to indicate that an E/M service or eye exam, which falls within global period of a major or minor surgery and is performed by a surgeon, is unrelated to surgery
  • Can only be submitted with E/M and eye exam codes
  • When documenting treatment of infection of wound, consider this part of post-operative care
  • Supporting documentation of unrelated ICD-9 or ICD-10 code and/or additional documentation may be requested to support that E/M service is unrelated to surgery  
  • If ICD-9 or ICD-10 code for E/M service clearly supports visit is unrelated to surgery, there is no need to submit additional documentation

Incorrect Use

  • Not appropriate when E/M is for surgical complication or injection
  • Not appropriate when patient is admitted to a skilled nursing facility for a condition that is related to surgery
  • Not appropriate when E/M is not clearly shown to be unrelated to surgery in medical record documentation
  • Not appropriate outside of post-op period of a procedure or on same day as procedure

Resource

 

Last Updated Thu, 25 Oct 2018 13:37:40 +0000