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Modifier 24 and 25

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.

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.

Key Points

  • 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 

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.

9921X-24                           N63 for the diagnosis

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Last revised December 17, 2020 - Betsy Nicoletti
Tags: Dermatology, modifiers, primary care

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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