Modifier 24 Description and Examples per CMS and AMA

Summary:

Learn about compliant usage of Modifier 24. Full descriptions and pictures on how iVECoder would help you decipher this useful but sometimes confusion modifier.

What is Modifier 24?

Modifier Description

Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period: The physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service.

Appropriate Usage of Modifier 24

• Append modifier 24 to the E/M procedure code.
• Use on an unrelated E/M service beginning the day after a procedure, when the E/M is performed by the same physician* during the 10 or 90 day post-operative period.
• Use modifier 24 on the E/M if documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.
• Use modifier 24 on the E/M code when the same physician* is managing immunosuppressant therapy during the post-operative period of a transplant.
• Use modifier 24 on the E/M code when the same physician* is managing chemotherapy during the post-operative period of a procedure.
• When the same physician* provides unrelated critical care during the post-operative period.
  

Inappropriate Usage of Modifier 24

• Do not use when the E/M is for a surgical complication or infection. This treatment is part of the surgery package.
• Do not use when the service is removal of sutures or other wound treatment. This treatment is part of the surgery package.
• Do not use when the surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
• Do not use unless the medical record documentation clearly indicates the E/M was unrelated to the surgery.
• Do not use outside of the post-op period of a procedure.
• Do not use on the same day as a procedure.
  

Additional Notes on Modifier 24

When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure, modifier 78 is still the correct modifier to use. Lastly, the effective dates for Modifier 24 was on 1/1/1984.

Global Period for Surgery: Modifier 24

Ever wondered about the Global period of a surgery? Have you searched that ridiculously large database of CMS.gov or pulled out your latest code book? No need. iVECoder will populate it for you. Patient comes into your clinic with visual discomfort of the right eye (H53.141), you provide an inital diagnosis of Cataract of the Right Eye (H25.811), and perform a Cataract Removal (CPT 66984). How do you bill it?

Well if you had iVECoder you would simply plug them in the Adjudication screen to make sure you could get paid from CMS and/or Medicaid for this service and your codes were right or by searching the top navigational link. See pictures below.

Modifier 24 and CPT 44950 Example

Patient complains of abdominal pain (R10.30), with primary diagnosis resulting in Acute Appendicitis with Generalized Peritonitis (K35.20), which in turn yields an Appendectomy (CPT 44950). Will it be approved with a modifier 24? Let’s ask iVECoder shall we…

Yes, but only billed under facility codes. See below:

Using iVECoder to Research Modifier 24 and other Modifiers

Now you can perform deep dives into the modifier for full comprehension and future applications decreasing denials, and the financial and emotional stress that comes from denials.

Summary of CPT 99202 and Initial Consult Coding

Understanding every Modifier is not as hard as all the other codes, however CMS and AMA are continually tweaking the language and requirements from which a modifier, like Modifer 24, can be applied. While we hope you found this information helpful, why not throw away those coding books and let AI help you find the exact code(s) that can be approved the first time. If you’re interested in a FREE Trial just click the link below or email us at info@pcgsoftware.com 

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Will Schmidt joined PCG Software as their Chief Strategy Officer in November 2022. Prior to PCG, Schmidt lead TNH as their Sr. Vice President to become the 7th largest pharmacy in the nation. He then went on to consult with and serve as Interim CEO or Consultant to over 20 different companies specializing in profit strategies, operational efficiencies, vendor relations and partnerships, and exit strategies, include an international Revenue Cycle Management Company.