Wiki Modifier 24

[Tiffanyw07]

I’m needing help understanding when to use 24 mod on a E/M service. I code for Obgyn- I looked up info on 24 on this fact sheet its a little confusing.
When to apply 24 it states- documentation indicates service was exclusively for treatment of the underlying condition & not for post op care
When not to apply 24
The E/M is for a surgical complication or infection

Examples I see in my Obgyn when they submit a E/M
Scenario 1. Vaginal delivery within global period- comes in for vaginal bleeding/blood clots? Would I use a mod?
Scenario 2. C section within global period- soreness around incision ?
Scenario 3. They come in for sinus infection and just had a baby within global period? This one you would use a 24 mod. I’m pretty sure I understand this scenario when it has nothing to do with their procedure.

 

[csperoni]

I’m needing help understanding when to use 24 mod on a E/M service. I code for Obgyn- I looked up info on 24 on this fact sheet its a little confusing.
When to apply 24 it states- documentation indicates service was exclusively for treatment of the underlying condition & not for post op care
When not to apply 24
The E/M is for a surgical complication or infection

Examples I see in my Obgyn when they submit a E/M
Scenario 1. Vaginal delivery within global period- comes in for vaginal bleeding/blood clots? Would I use a mod?
Scenario 2. C section within global period- soreness around incision ?
Scenario 3. They come in for sinus infection and just had a baby within global period? This one you would use a 24 mod. I’m pretty sure I understand this scenario when it has nothing to do with their procedure.

In both 1&2, it seems those are typical, routine postop with perhaps minor complications. I would not code an E&M service with -24. Scenario 3, if the provider is treating the sinus infection, level the visit only on the work related to the sinus infection and add -24.
I'm not certain what fact sheet you are referring to, but the statement: "documentation indicates service was exclusively for treatment of the underlying condition & not for post op care", I would disagree with. For example patient had a postop appointment and also mentions another (unrelated) problem. If both postop care and treatment not included in the global package are rendered, the visit is billable with -24. The key is to level the service ONLY on the care not related.
The CMS global surgery booklet has been very helpful to me in the past, but addresses global surgical package in general - not maternity. ACOG's payment & policy portal is a great resource specific to maternity and obgyn.