This summary of the rules regarding modifier 24 and 25 is a must read; it includes specific examples of when to report both an E/M and a procedure and when to report just the procedure. For additional information, see the article on Global Surgical Package.
Members can also download the modifier 25 audit tool, and using modifier 25 quick reference sheet.
Modifier 24
- There is a difference in the Medicare definition of what is included in the global post-op care and in the CPT® definition.
- Medicare states that all medical and surgical follow-up and complications that do not require a return trip to the OR are included in the global payment.
- CPT® says the typical follow-up is included in the global payment. Both allow payment for care of unrelated conditions.
CPT® definition
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period.
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 circumstance may be reported by adding modifier 24 to the appropriate level of service.
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