Modifier 24

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

Instructions

  • Use 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
  • Only submit with E/M and eye exam codes
  • When submitted, supporting documentation of an unrelated ICD-9 code and/or additional documentation may be requested to support that E/M service is unrelated to surgery
  • If ICD-10 code for E/M service clearly supports that visit was unrelated to surgery, there is no need to submit additional documentation

Special Instruction for Ophthalmologists

  • If exam and prior surgery were performed on different eyes, this information must be indicated in appropriate field. Modifiers RT and LT may not be submitted with eye exam codes

Correct Use

  • Do not use when E/M is for a surgical complication or injection
  • Do not use when patient is admitted to a skilled nursing facility for a condition that is related to surgery
  • Do not use when E/M is not clearly shown to be unrelated to surgery in medical record documentation
  • Do not use outside of post-op period of a procedure or on same day as procedure
  • When documenting treatment of an infection of a wound, consider this part of post-operative care

Coding Claim Example

The patient comes in for a lesion removal, which has 10 postoperative global days. Four days later, patient comes in for a new condition of upper respiratory infection (URI). Since the URI is a new, unrelated condition during the postoperative period, modifier 24 is appended to the E/M code. If modifier 24 is not appended to the E/M code, it will be denied as included in the global package of the surgery. The second diagnosis code must be unrelated to the lesion removal to allow for separate payment. Even though there are two separate unrelated diagnosis codes on the claim, the new diagnosis alone will not pay the claim.

Treatment Description CPT/Modifier PT/Modifier
Destruction of premalignant lesion 17000
E/M for upper respiratory infection (URI) 99213 24

 

Resources

 

Last Updated Dec 09 , 2023