Coding Modifier 24
As per the CPT descriptive, modifier 24 is defined as an “Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Healthcare Professional During a Postoperative Period.” We would utilize this modifier to describe an unrelated E/M service during the global period of another procedure. Modifier 24 designates the provider is evaluating the patient for a new problem, and the evaluation is not included in a previous procedure’s global surgical package.
It is important to note when reporting modifier 24, the evaluation and management service must meet three criteria. The E/M service occurs during the postoperative period of another procedure, the current E/M service is unrelated to the previous procedure (you should be able to connect the E/M service to a separate, distinct diagnosis), and the same provider (or one with the same tax ID) who performed the previous procedure provides the E/M.
Q: A 45-year-old female sees her physician for a follow-up of a repaired damaged nerve in her finger. During the visit, she told the doctor she fell and hit her little toe this morning and now it is red and swollen. The patient wants to make sure it’s not broken. The physician examines the toe and reassures her it is not fractured. The doctor also examines the finger, which is healing well with no infection. Select the E/M service for this visit.
A: 99212-24 Rationale: Although the patient is in their postoperative period from their procedure, the physician can bill this E/M visit and append modifier 24. The examination is unrelated to the nerve repair surgery.
Reference: FY 2023 CPT codebook
