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 

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.

Why?

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