Reimbursement Issues Related to Modifier 24

CPT defines modifier 24 as “Unrelated evaluation and management services by the same physician during a postoperative period.”  It goes on to say “The physician 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 is supported by the Medicare Claims Processing Manual (MCPM) Chapter 12, §40.1B, “… may be paid for separately.  …  Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery; …

This FAQ addresses the following:

  1. Are all exams during the postoperative period following surgery included in the global surgical fee?
  2. What does modifier 24 mean?
  3. What does “unrelated” mean in this context?
  4. May modifier 24 be used to report the decision for surgery for cataract surgery in the opposite eye?
  5. Should modifier 24 be used to report a diagnostic test in the global surgery period?
  6. Will utilization of modifier 24 trigger a postpayment audit?
  7. What other modifiers pertain to surgery in the global period?

Three case studies are also included.

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