How to use modifier 24

​Definition: Unrelated evaluation and management (E/M) service by the same physician* during a postoperative period 

APPROPRIATE:

• Append modifier 24 to the E/M procedure code (Not Procedure Codes!)
• Use on an unrelated E/M service beginning the day after a procedure, when the E/M is performed by the same physician* during the 10 or 90 day post-operative period. 
• Use modifier 24 on the E/M if documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care. 
• Use modifier 24 on the E/M code when the same physician* is managing immunosuppressant therapy during the post-operative period of a transplant. 
• Use modifier 24 on the E/M code when the same physician* is managing chemotherapy during the post-operative period of a procedure. 
• When the same physician* provides unrelated critical care during the post-operative period. 

INAPPROPRIATE:

• Do not use when the E/M is for a surgical complication or infection. This treatment is part of the surgery package. 
• Do not use when the service is removal of sutures or other wound treatment. This treatment is part of the surgery package. 
• Do not use when the surgeon admits a patient to a skilled nursing facility for a condition related to the surgery. 
• Do not use unless the medical record documentation clearly indicates the E/M was unrelated to the surgery. 
• Do not use outside of the post-op period of a procedure. 
• Do not use on the same day as a procedure. 

*Same physician - Medicare regulation states: "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician."

Reporting Multiple Surgery Modifiers on the Same Claim Line
The following is an example of appropriate reporting of both modifiers 24 (Unrelated E/M by the same physician during a postoperative period), and 25 (Significant, separately identifiable E/M by the same physician on the same day of the procedure or other service), on the same E/M code.

Many are still confused on this. But here... 
"A physician performs a major surgery and within the global period sees the patient for an unrelated E/M visit. During this unrelated E/M visit, the physician determines the necessity of a minor surgery or other procedure. This minor surgery/other procedure is significant and separately identifiable from the E/M and unrelated to the original major surgery. Both the 24 and 25 modifiers are appropriate to add to the E/M code. The 24 modifier is appropriate because the E/M service is unrelated and during the postoperative period of the major surgery. The 25 modifier is necessary to identify that the minor surgery/procedure performed on the same day is separately identifiable from the E/M service. In addition, the minor surgery procedure code may need a 79 modifier to indicate the procedure is not related to the major surgery."