Modifier 24

July 27th, 2015 - Codapedia Editor
Categories:   Coding   Modifiers   Surgical Billing & Coding  
0 Votes - Sign in to vote or comment.

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.


Latest articles:  (any category)

How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
November 18th, 2020 - Raquel Shumway
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
Cross-A-Code Instructions in Find-A-Code
November 18th, 2020 - Raquel Shumway
Cross-A-Codeis a toll found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
COVID Vaccine Codes Announced
November 11th, 2020 - Wyn Staheli, Director of Research
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Are You Aware of the 2021 Star Rating System Updates?
November 5th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:  Quality of ...
Special Needs Plans Help Beneficiaries and Risk Adjustment Reporting
October 22nd, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...
CMS Expands Telehealth Again
October 20th, 2020 - Wyn Staheli, Director of Research
On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.
Significant COVID-19 Code Changes as of October 6
October 8th, 2020 - Wyn Staheli, Director of Research
Significan COVID-19 Code Changes as of October 6



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association