Otolaryngology Coding Alert

2021 office/outpatient E/M changes won’t affect its use, experts say.

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 evaluation and management (E/M) coding, as it allows your provider to obtain valuable reimbursement when they conduct an unrelated E/M service during the global period of another service.

So, to learn how — or to see if — you’re using it correctly, apply the following three questions to the two scenarios below and see if you come up with the same conclusions as our experts. And to add to your modifier 24 understanding, read on to learn if use of the modifier has changed with the 2021 office/ outpatient E/M guidelines.

How Modifier 24 Should Be Used

If you read the modifier’s descriptor closely, you’ll see three key details that you can turn into questions, which you can then apply to any scenario to see if you are using the modifier correctly.

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?

Basically stated, 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 that prior service, you should append modifier 24 to the unrelated E/M to separate both services, providing your documentation can justify that the E/M is not a part of the regular postoperative follow-up for the original procedure or is not related to the original procedure.

Still confused? Let’s see if these scenarios can provide some clarity.

Scenario 1: An established patient comes into the office for a follow-up visit a week after your otolaryngologist performed a bilateral submucosal turbinate ablation of the inferior turbinates, which had been previously coded with 30802 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)). While in the office, the patient tells your otolaryngologist that they have been experiencing ear pain and is diagnosed with acute otitis media.

Can You Bill an E/M and Apply Modifier 24?

In this case, yes. Here’s why.

“Because you are still in the 10-day global period for the 30802 inferior turbinate reduction, you can bill and get reimbursed for an office/outpatient E/M visit in this case,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. “But you will need to have the 24 modifier on the visit to indicate that it is not related to the global postoperative period associated with 30802. And you will have to associate the acute otitis media, and not the hypertrophy of the turbinates, as the diagnosis for the E/M because this problem is in no way related to the turbinates,” Holle adds.

Scenario 2: Three days after your provider performed the same bilateral submucosal turbinate ablation of the inferior turbinates procedure for a Medicare Part B patient, the patient returns with the pain and oozing coming from the right nostril. The physician diagnoses right inferior turbinate postsurgical infection and treats the site with topical antibiotics.

Can You Bill an E/M and Apply Modifier 24?

In this case, no. Here’s why.v

This surgery was for a Medicare Part B patient. Unlike instructions provided in CPT^® code book (page 84), Medicare does not cover any postoperative complications treatment unless it requires a return to the operating room (OR). Like the previous scenario, you’re still working with a 10-day postoperative period for 30802. This time, however, “you would not be able to use modifier 24 and report an additional visit because the visit is for complications related to the original turbinate surgery and the visit is occurring during the global period of the related procedure,” states Holle.