Saturday, 14 January 2017

Modifier 24

Unrelated Evaluation and Management (E/M) service performed by the same physician during the postoperative period


This modifier can be used to indicate that an E/M service or eye exam, which falls within the global period of a major or minor surgery and is performed by a surgeon, is unrelated to the surgery.

This modifier can only be submitted with E/M and eye exam codes.

When this modifier is submitted, supporting documentation of an unrelated ICD-9 code and/or additional documentation may be requested to support that the E/M service is unrelated to the surgery.  

If the ICD-9 code for the E/M service clearly supports that the visit was unrelated to the surgery, there is no need to submit additional documentation.

Special Instruction for Ophthalmologists

If the exam and prior surgery were performed on different eyes, this information needs to be indicated in the appropriate field. HCPCS modifiers RT and LT may not be submitted with eye exam codes.

Correct Use

Do not use this modifier when the E/M is for a surgical complication or injection.

When documenting treatment of an infection of a wound, consider this part of post-operative care.

Do not use this modifier when the patient is admitted to a skilled nursing facility for a condition that is related to the surgery.

Do not use this modifier when the E/M is not clearly shown to be unrelated to the surgery in the medical record documentation.

Do not use this modifier outside of the post-op period of a procedure or on the same day as the procedure.

Coding Claim Example

The patient comes in for a lesion removal, which has 10 postoperative global days. Four days later, patient comes in for a new condition of upper respiratory infection (URI). Since the URI is a new, unrelated condition during the postoperative period, modifier 24 is appended to the E/M code. 

If modifier 24 is not appended to the E/M code, it will be denied as included in the global package of the surgery. The second diagnosis code must be unrelated to the lesion removal to allow for separate payment. Even though there are two separate unrelated diagnosis codes on the claim, the new diagnosis alone will not pay the claim.

Treatment Description : Destruction of premalignant lesion
CPT 17000 /Modifier PT

Modifier 24

CPT 99213E/M for upper respiratory infection (URI).

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