Using Care When Using Modifier 24

If you are a practitioner or medical biller that has a client who sees patients in need of services for post operative complications and you are bundling the services into the global period of surgery, you could possibly be missing thousands of dollars in reimbursements yearly using this method of doing your medical billing.

In many cases you can legitimately report patient evals made during the post-op period, according to the individual carrier’s rules. A good rule of thumb for most carriers is if the post operative complication evaluation is unrelated to the original procedure and this can usually be distinguished by medical necessity and date alone, then you can report it a separate incident using Modifier 24 which is “unrelated evaluation and management service by the same physician during a postoperative period” if the physician evaluates the patient for a complication during the global period of a previous procedure.

Generally, carriers do not consider infections that occur during the post operative period as ‘related’ to the initial surgery, most will pay for the evaluation.

Be aware when using Modifier 24 that Medicare will pay differently. Medicare will only pay for services rendered during the postoperative period if the patient was returned to the operating room.

Make sure that you know the guidelines that your carrier is willing to reimburse before you file your medical billing claim. This will insure that you get the maximum reimbursements that you’re due.

View all Articles by: Melissa Clark, CCS-P