CPT Code Spotlight – Modifier 24

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Modifier 24

Modifiers can be extremely confusing, especially when it comes to deciding which one to use. Collecting the wrong once can lead to payment denials from insurance companies and puts practices at risk for payers requesting refunds. This post will go over Modifier 24.

 

What is Modifier 24?

Modifier 24 is one of the easier modifiers to understand and is relatively straightforward. It’s used for an unrelated E/M (evaluation and management) service provided by the same physician during a post-operative period. It indicates a visit during the post-operative period to the same doctor, but that it’s unrelated to the original procedure.

 

When to Use Modifier 24

There are two main reasons to use modifier 24. The first reason is it’s an E/M service. This is a typical check-up like going to the doctor’s office for a physical. There are no procedures scheduled or planned. It’s simply an evaluation of the patient during the post-operative period.

The second reason is it’s unrelated to a previous procedure. The two procedures have no connection to one another, but the same physician provides treatment.

 

Examples of When to Use Modifier 24

One example is a surgeon performing a hernia repair. This takes place on August 5, and the procedures has a 60-day global period, so any post-operative care is included in the payment for the hernia. The same patient returns on September 22 to have a breast lump evaluated. This would fall under modifier 24 because the breast lump is the reason for the visit.

Another example is an orthopedist treating an ankle sprain on April 2 and the patient returns on April 22 for joint pain. This would be this modifier because the patient came in for joint pain, which is different than treating an ankle sprain.

A final example is a surgeon managing immunosuppressant therapy during a post-operative period for a transplant. This would qualify as modifier 24 because the therapy is different than the transplant itself.

 

When Not to Use Modifier 24

Sometimes, it can be easier to know when not to use a specific modifier. Below are examples of what would not constitute the use of modifier 24:

  • It’s not an E/M service
  • It’s not during the post-operative period
  • The service is conducted by a different physician
  • The service is related to the previous procedure
  • Testing is done in the post-operative period.

 

Compated to 58, 59, 78, and 79, modifier 24 is relatively straightforward. The biggest takeaway is it’s an unrelated E/M visit during the post-operative period. The post-operative period will differ depending on the procedure performed, so it’s important to know how long it is depending on the treatment.

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