Modifier 24 is appended to an Evaluation and Management service by the same physician during a post op period. See the CPT® book for the complete definition.
This modifier may only be used with E/M services.
When a physician bills for a surgical procedure, the post op care for that procedure is included in the global payment. Surgical procedures have 0, 10, or 90 days. That means, all of the care provided during that period is paid for in the global payment, and post op visits may not be billed separately.
However, if the physician sees the patient for a problem unrelated to the surgery, that service is payable. Indicate that the service was unrelated to the surgery using modifier 24. For example, an Orthopedist may perform knee surgery on a patient, with a 90 day global period. On day 55 of the post op period, the patient comes in to the office complaining of numbness and tingling in his right hand. This visit is unrelated to the surgery. Submit the E/M service with a 24 modifier. Be sure that the diagnosis reflects that the visit was not a post op service.
Without the 24 modifier, the claim will be denied as being included in the global package.
A surgeon may only bill for critical care during the post op period when the critical care is not related to the reason for surgery. In general, a diagnosis code in teh range of 800.0 through 959.9 (except 930-939) are acceptable. These are trauma related. Non-trauma related critical care, unrelated to the surgery is separately payable, but be prepared to send the notes. The question of "related" and "unrelated" are not always crystal clear.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
More than 43% of Medicare beneficiaries are not enrolled in Medicare Advantage plans, which were established to control costs and improve quality. However, as noted in the March MedPac Report Executive Summary of 2021, these plans average an estimated 104% of Medicare Fee-For-Service (FFS) spending. How does CMS plan to manage Medicare Advantage plans now?
Providers need to begin preparations for how to handle a return to pre-COVID-19 public health emergency (PHE) policies. As the saying goes, "you can't put the rabbit back in the hat." Some COVID-19 PHE policies are so well liked it will be very difficult for the government to return to pre-COVID-19 policies. For now, we have at least the promise of a 60-day notice to all governors precipitating the end of the PHE.
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...
Question: If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim?
Answer: According to CMS, “The service period for CPT 99490 ...
When reporting CCM or TCM codes, you will only get reimbursed for what is allowed. The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...
Question: Is there a financial penalty for billing over the allowed amount?
Answer: Yes, if you are submitting claims to a contracted provider, you cannot bill over the contracted amount of your fee schedule. This is called balanced billing. There is also the no-surprise rule that protects insured and non-insured or ...
