Question: A patient developed a post-op infection during the global period and returned to the operating room (OR). Can we bill the E/M hospital visit with a modifier 24? California Subscriber Answer: You can only append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to an E/M service when the physician renders an E/M during the patient’s global surgery period that is not related to the patient’s surgery. If the infection is related to the surgery, the MAC considers it part of the original procedure. However, if the need is there to return to the operating room, the physician could bill the service with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). When you report modifier 24, the E/M service must meet the following requirements: According to the MAC Noridian, you should never use modifier 24 in the following situations: