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.
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.
- Use on an E/M service during the global period, when the visit is unrelated to the surgery
- Use a different diagnosis code
- Only needed by the surgeon who did the surgery
9921X-24 N63 for the diagnosis
A patient has a hernia repair on July 3, followed by normal post-op visits performed. Patient calls office in late August, and asks to be seen for a “lump.” Patient presents with a breast lump. Bill for this established patient visit with the diagnosis of breast lump. Using a different diagnosis and modifier 24 allows you to get paid for an unrelated E/M service during the global period.
Tip: For commercial payers, may use modifier 24 for complications.