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Modifier 24

Modifier 24
24 Modifier Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: 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.

An E/M service can be coded with modifier 24 to indicate a visit in the postoperative period that is unrelated to the original procedure (surgery). This modifier is not valid when coded with surgeries or other types of services. It is not appropriate for modifier 24 to be coded with diagnostic tests performed in the postoperative period. These are not part of the global surgical allowance and are always considered separately.

In most cases, diagnosis codes that apply to the E/M service are different from the diagnosis codes indicated on the original procedure. However, in rare circumstances, the diagnoses are the same, but the services are unrelated; if so, this information should be documented with the claim, either in the narrative field on electronic claims or on an attachment with paper claims.

Hospital visits by the surgeon during the same hospitalization as the surgery are considered related to the surgery; however, separate payment for such visits can be allowed if one of the following conditions applies:

* Immunotherapy management furnished by the transplant surgeon. Immunosuppressant therapy following transplant surgery is covered separately from other postoperative services. That is, postoperative immunosuppressant therapy is not part of the global fee allowance for the transplant surgery. This coverage applies regardless of the setting.

* The surgeon provides critical care for a burn or trauma patient.
* The diagnosis is unrelated to the original surgery.

Outpatient visits during the postoperative period are allowed during a global fee period if the claim documentation demonstrates that the visit is for a diagnosis unrelated to the original surgery. Use modifier 24 in this situation.

Office visits during the postoperative period are not covered unless they are submitted with modifier 24 to indicate they are unrelated to the surgery. Modifier 24 is primarily for use only by the surgeon. A different diagnosis code may be sufficient to show the procedure is unrelated to the surgery; however, it may not be required. Documentation submitted should fully explain how the E/M service is unrelated to the surgical procedure.

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