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.

Thank you for your help!

 

[natashalage]

Hello, I am not an expert. here are my thoughts to your cases:
1. comes for vaginal bleeding/clots. I am not sure here, I think pt will probably have a procedure done, so e/m will be included here. If not a procedure like 59160, and pt has a bleeding... (we previously, this year, discussed similar question, please review this Forum) and the delivery has no global days, then a complication/bleeding with clots etc, will be coded as e/m. Again, I am not sure.
2. soreness is related to the surgery and is not a complication= no E/M.
3. sinus infection... if we have good documentation for managing, treating this condition, then I would code E/M. IF simple mentioning of it, that could be a postpartum visit. Sorry, I am not an expert, still learning.

 

[nielynco]

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.

Thank you for your help!

Medicare is the one that has the rule that no payment will be made for a complication of surgery. The complication, in their case, CANNOT be related to the performance of the surgery. They will pay for complications not related to surgery. CPT states that complications of pregnancy should be billed separately, but the modifier 24 is only reported when that E/M is not related to the original procedure. The non-Medicare payer will decide. Scenario 1: Report with a modifier 24 for any payer but Medicare. Scenario 2: included as an expected complication so do not bill. Scenario 3: Report with a modifier 24 if there is a separate E/M that can actually be billed based on the documentation. If the patient simply mentions the problem, but the provider does not evaluate or treat it, but then goes on to do a PP check, it is not billable.