Understanding E/M modifiers is important for both revenue and compliance. Failing to apply the correct modifier reduces revenue. Applying the wrong modifier or using it when it is not accurate is a compliance issue and puts the practice at risk for payback and disclosures. For additional information, see the article on Global Surgical Package.

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 or Other Qualified Health Care Professional During a Postoperative Period.

The physician or other qualified health care professional 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 E/M service.