Modifier 24

It’s important to know the ins and outs of this frequently used modifier. Not reporting or misusing modifier 24 can result in claim denials and reduced reimbursed.

The lowdown on modifier 24

This modifier is used when an E/M service is provided by the same physician or another provider of the same specialty within the practice during that 10- or 90-day postoperative period of a previous surgery. To report the encounter with modifier 24, the E/M must be unrelated E/M to the previous procedure.

During the global surgery period, some services provided in relation to the procedure, such as dressing changes, suture removals, or addressing minor complications to the procedure, are included in the procedure’s global surgery package. These services cannot be billed separately to the payer or to the patient. Most complications within the global period are considered part of the original surgery and an encounter for that complication is considered related to the procedure, so the E/M is not separately billable.

If another dermatologist in your practice performed the surgery, and you see the patient for a possible complication in the global period of that surgery, the encounter would be considered related to the surgery and not separately reportable.

Now, if the surgeon who performed the procedure is not part of your practice, or doesn’t have the same specialty as the dermatologist performing the E/M, there is a possibility you can bill it as an unrelated visit. In this case, the carrier will view this as if you saw the patient for a new presenting problem. In this case, you don’t need to use modifier 24.

Test your knowledge

You can test your knowledge of modifier coding by taking a short Academy quiz, or see other coding quizzes.

Related Academy resources