What is modifier 24 used for?
Asked by: Prof. Dianna D'Amore | Last update: August 27, 2025Score: 5/5 (67 votes)
When should a 24 modifier be used?
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.
What is the difference between modifier 24 and 25?
Modifier 24 refers to the evaluation and management services provided to the patient on the day of a surgical procedure unrelated to the procedure itself. Modifier 25 identifies the evaluation and management services as unique services provided on the same day by the same medical professional.
What is an example of inappropriate use of modifier 24?
Inappropriate use: It would be inappropriate to report an E/M code with Modifier 24 for routine postoperative care or for managing a surgical complication such as infection, removal of sutures, or other wound treatment, as these treatments are already part of the surgery package and have been “prepaid.” For example, if ...
What does code 24 mean in a hospital?
Inadequate documentation: Proper documentation is crucial for accurate billing and reimbursement. If the healthcare provider fails to provide sufficient documentation to support the charges or if the documentation is incomplete or illegible, the claim may be denied with code 24.
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What is medical reason code 24?
Lack of prior authorization: Some services require prior authorization from the managed care plan before they can be performed or reimbursed. If the provider fails to obtain the necessary authorization or if the authorization is not properly documented, the claim may be denied with code 24.
What is procedure code 24?
Modifier 24 is applied to evaluation and management services provided during a postoperative care , but unrelated to the surgery itself.
What is modifier 24 and 78?
It's similar to modifier 78 because both refer to “unrelated” service by the same physician in the post-op period. However, modifier 24 is different from modifier 78 because 24 refers only to E/M service. 78 does not refer to E/M service, but to non-E/M procedures or services.
How to tell if CPT codes are bundled?
This depends on medical coding rules. Bundling occurs when procedures or services with unique CPT or HCPCS Level II codes are billed together under one code. Unbundling is when two or more codes that are normally part of a single procedure can be billed separately.
What qualifies as a 25 modifier?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Does modifier 25 reduce payment?
Automatic reduction in payment for the second code to account for what they perceive to be “overlap” between the two codes (e.g., a Preventive Medicine Service E/M code reported with an Office or Other Outpatient Service E/M code appended with modifier 25 allows payment of the Preventive Medicine Service code at 100 ...
Can you bill modifier 24 and 57 together?
E/M service resulting in initial decision to perform major surgery is furnished during post-operative period of another unrelated procedure, then the E/M service must be billed with both the 24 and 57 modifiers.
What is a 26 modifier?
• Modifier 26 is appended when a physician provides the professional component only of the global fee. and when the physician prepares a written interpretation and report. • Modifier 26 should only be appended to codes which are listed in the CMS NPFSRVF as modifier 26. appropriate.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What is the postoperative period?
The postoperative period includes the time from the end of the procedure in the operating room until the woman has resumed her normal routine and lifestyle. Postoperative complications may occur at any time; however, early recognition and management will often preclude larger problems.
Is CPT 52000 a surgery code?
A cystourethroscopy (e.g., CPT code 52000) or cystourethroscopy with ureteroscopy (e.g., CPT code 52351) performed near the termination of an intra-abdominal, intra-pelvic, or retroperitoneal surgical procedure to assure that there was no intraoperative injury to the ureters or urinary bladder and that they are ...
What is an example of a bundled code?
The most common scenarios are when the two bundled codes are performed in separate structures (e.g., opposite eyes) or separate incisions. For example, a cataract surgery (CPT code 66984) in the right eye is performed the same day as an Nd:YAG laser in the left eye (CPT code 66821).
Can you bill without a CPT code?
When billing a service or procedure, select the CPT or HCPCS code that accurately identifies the service or procedure performed. If no such code exists, report the service or procedure using the appropriate unlisted procedure or Not Otherwise Classified (NOC) code (which often end in 99).
What is the order of modifiers on claims?
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario.
When to use modifier 24?
- This modifier may be used to indicate that an evaluation and management (E/M) service or eye exam, which falls within the global period of a major or minor surgery and which is performed by the surgeon, is unrelated to the surgery. ...
- This modifier may only be submitted with E/M and eye exam codes.
What is an example of a 78 modifier?
Modifier 78
Examples include a post-surgical infection, debridement that requires a return to the OR, and hemorrhage after surgery.
Can modifier 24 and 25 be used together?
You can use modifiers 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) and 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the ...
When to use modifier 79?
Modifier 79 is used to indicate an unrelated procedure that was performed by the same physician or other qualified health care professional during the post-operative period.