This modifier may be used to indicate that an evaluation and management (E/M) service performed within the post-operative period (the global period of a major or minor surgery, which can range from 0 to 90 days) is unrelated to the prior procedure.
Note: Unlike under Medicare, Priority Health does not treat providers within the same specialty as a single physician. Claims are processed and clinical edits applied by each rendering physician.
Correct use of Modifier 24
Visit for a new problem unrelated to the procedure
Visit for treatment of the underlying condition that prompted the procedure
Visit for treatment of complications, exacerbation or recurrence
The E/M service is for the treatment of a problem unrelated to the procedure (supported by a different ICD-10 code)
Note: a different diagnosis code will not automatically bypass any clinical edits Priority Health has in place related to E/M services performed in the post-operative period.
Incorrect use of Modifier 24
The service is not performed during the global period
A different physician conducts the service
The service is related to the original procedure
The modifier is appended to critical care codes 99291 or 99292
Resources
Modifier 24 Fact Sheet (WPS)