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.
Members can also download the modifier 25 audit tool.
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 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.
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