Revenue Cycle Insider

Question: What are the proper situations to use modifier 24? My colleague says that you can only use it for an evaluation and management (E/M) service during a global period if the service is unrelated to the global period services.

Michigan Subscriber

Answer: If you’re ever in doubt about the services involved during an encounter, you should check with your provider. In this situation, they’d be able to clarify whether an E/M service is eligible for modifier 24. If you can’t get the information you need, you can check with the respective payer before submitting the claim.

Knowing how to use modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) correctly is a significant component of E/M coding — it allows your provider to obtain valuable reimbursement when they offer an unrelated E/M service during the global period of another service.

If you read the modifier’s descriptor closely, you can find three details that can help you determine whether appending modifier 24 is appropriate:

1. Is the service an E/M?

2. Does the E/M occur during the global period of another service that has been performed by the same provider performing the E/M?

3. Is the E/M unrelated to that other service?

To sum it up: If your provider performs a procedure that has a global package, then sees a patient for an E/M service for an unrelated problem at any point during the global period of the prior service, you should append modifier 24 to the unrelated E/M to separate both services, providing your documentation can justify the E/M is not a part of the regular post-op follow-up for the original procedure or is not related to the original procedure.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC