Primary Care Coding Alert

Question: What are the proper situations to use modifier 24? We are having a debate in the office about when you can or cannot use it.

AAPC Forum Participant

Answer: 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.

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

So, to learn if you’re using it correctly in a given situation, apply the following three questions to the scenario:

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 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 postop follow-up for the original procedure or is not related to the original procedure.

Best bet: If you have any doubt as to whether an E/M is modifier 24-eligible, check with your provider. They should be able to clarify any questions you have about the encounter. If that option doesn’t pan out, you can always check with your payer before filing the claim.