Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.
Medicare defines same physician as physicians in the same group practice who are of the same specialty. In this instance they must bill and be paid as though they were a single physician.
Modifier 24 is applied to two code sets:
E/M (Evaluation and management) services (99201-99499).
General ophthalmological services (92002-92014), which are eye examination codes.
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 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 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.
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 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 postoperative care.
Reporting surgical procedures, labs, x-rays, or supply codes.