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:
- Are all exams during the postoperative period following surgery included in the global surgical fee?
- What does modifier 24 mean?
- What does “unrelated” mean in this context?
- May modifier 24 be used to report the decision for surgery for cataract surgery in the opposite eye?
- Do we need modifier 24 to report a diagnostic test in the global surgery period?
- Will utilization of modifier 24 trigger a postpayment audit?
- What other modifiers pertain to services in the global period?
Three case studies are also included.
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