Modifier 24 Unrelated E/M Service and their impact on Reimbursements

The Centers for Medicare & Medicaid Services recently published proposed rules for proper use of modifier 24 and 25 in evaluation and management (E&M) coding. Recognizing the global process period is critical for attributing modifiers 24 and 25. Global periods are typically zero, ten, or ninety days after the process, with additional preoperative days possible.

Modifier 24’s Appropriate Use

In the following cases, use modifier 24 in conjunction with the appropriate level of E&M service:

The same physician performs an unassociated E&M service starting the day after the 10- or 90-day postoperative period.The information indicates that the service was solely for the treatment of the underlying medical condition and not for postoperative care.The same physician manages immunosuppressive therapy during the postoperative period of a transplant.The same physician works chemotherapy during the postoperative period of a procedure.The same physician performs unrelated intensive care during the postoperative period. The exact diagnosis as the original method could be used for the new E&M service if the problem arises at a different anatomical site.

Modifier 24 should not be used in the following situations:

The E&M service is for surgical complications or diseases.The service is for surgical removal or other wound care.The surgeon admits a patient to a skilled nursing facility for a surgical-related condition.The paperwork in the medical records clearly shows that the E&M service is associated with the surgery.The service is provided outside of the procedure’s post-op period.Services are provided on the same day as the procedure.Regular postoperative exams are conducted.

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