Last Modified: 5/8/2024
Location: FL, PR, USVI
Business: Part B
Modifier 24 is defined as an unrelated evaluation and management (E/M) service by the same physician or other qualified health care professional during a post-operative period.
Medicare defines same physician as physicians in the same group practice who are of the same specialty. In this instance they must bill and be paid as though they were a single physician.
• Modifier 24 is applied to two code sets:
• E/M services (CPT codes 99202-99499).
• General ophthalmological services (CPT codes 92002-92014), which are eye examination codes.
• Use Modifier 24 with an appropriate level of E/M service
• Use Modifier 24 on an E/M when:
• An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period.
• Documentation indicates service was exclusively for treatment of the underlying condition and not for post-operative care.
• The same physician is managing immunosuppressant therapy during the post-operative period of an organ transplant.
• The same physician is managing chemotherapy during the post-operative period of a procedure.
• The same diagnosis as the original procedure could be used for the new E/M if the problem occurs at a different anatomical site.
• Do not use Modifier 24 when:
• The E/M is for a surgical complication or infection, removal of sutures or other wound treatment. These treatments are part of the surgery package.
• The surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
• The medical record documentation clearly indicates the E/M is related to the surgery.
• Outside of the post-op period of a procedure.
• Services are rendered on the same day as the procedure.
• Reporting exams performed for routine postoperative care.
• Reporting surgical procedures, labs, x-rays, or supply codes.
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