Coding: Using Appropriate Modifiers

Modifiers indicate that a service or procedure has been altered by a specific circumstance but not changed in its definition or code. They’re used to supplement, clarify, and specify the information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Modifiers create various reimbursement consequences for the associated visit.

Let’s look at appropriate and inappropriate uses of Modifier 24 this month:

Appropriate Use

Use Modifier 24 with the appropriate level of E/M service.

Use Modifier 24 on an E/M when:

• An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10- or 90-day post-operative period.
• Documentation indicates the service was exclusively for the treatment of the underlying condition and not for post-operative care.
• The same physician is managing immunosuppressant therapy during the post-operative period of a transplant.
• The same physician is managing chemotherapy during the post-operative period of a procedure.
• Unrelated critical care is performed by the same physician during the post-operative period.
• The same diagnosis as the original procedure could be used for the new E/M if the problem occurs at a different anatomical site.
  
  

Example: A patient has a hernia repair on June 3, followed by normal post-op visits. The patient calls the office in late July and asks to be seen for a lump. The patient presents with a breast lump. Bill for this established patient visit with the diagnosis of a breast lump. Using a different diagnosis and Modifier 24 allows you to get paid for an unrelated E/M service during the global period.

Inappropriate Use

Do not use Modifier 24 when:

• The E/M is for a surgical complication or infection. This treatment is part of the surgery package.
• The service is the removal of sutures or other wound treatment. This treatment is part of the surgery package.
• The surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
• The medical record documentation clearly indicates the E/M is related to the surgery.
• Outside of the post-op period of a procedure.
• Services are rendered on the same day as the procedure.
• Reporting exams performed for routine post-operative care.
• Reporting surgical procedures, labs, X-rays, or supply code.
  
  

Example: Including the use of Modifier 24 on the same day as a procedure or for admission of a patient to a skilled nursing facility for a condition related to the surgery.