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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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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

  • 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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Last revised January 3, 2022 - Betsy Nicoletti
Tags: dermatology_modifiers, modifiers, primary care_modifiers

Wondering about the rules for HCC coding?

Wondering what the rules are for HCC coding, and where you can find them? This video answers your questions. The topic is important to medical practices because risk-adjusted diagnosis coding is part of Medicare Advantage contracts, many commercial contracts and Accountable Care Organizations (ACOs). Sign up for our monthly newsletter to download the whitepaper and watch the video.

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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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