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Letter to the Editor. Novemer 2013
AAPC Cutting Edge Magazine
Modifier 24 Is Useful When Treating Underlying Problem “Related or Not? Pass the Modifier 24
Paternity Test” (August 2013, pages 24-25) did not fully explain the use of modifier 24 Unrelated evaluation and management service by the same physician or other qualified health care professional
during a postoperative period for the treatment of the underlying problem.
Medicare has defined postoperative care as related to recovery from the surgery, but treatment of the underlying problem is considered separately billable. Medicare considers pain control and wound care as postoperative care, along with any complication that doesn’t require a return to the operating room. The information below is provided on the Medicare administrative contractor (MAC) WPS® Medicare website (http://wpsmedicare.com/j8macpartb/resources/modifiers/modifier-24.shtml) to explain appropriate
use of modifier 24.
• Append modifier 24 to the evaluation and management (E/M) procedure code.
• 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 postoperative period.
• Use modifier 24 on the E/M if documentation indicates the service was exclusively for treatment of the underlying condition and not for postoperative care.
• Use modifier 24 on the E/M code when the same physician is managing immunosuppressant therapy during the postoperative period of a transplant.
• Use modifier 24 on the E/M code when the same physician* is managing chemotherapy during the postoperative period of a procedure.
When the same physician* provides unrelated critical care during the postoperative period
Same physican-Medicare regulation states: " Physicians in the same group pracitce who are in the same specialty must bill and be paid as though they were a single physician.” CPT® defines post-operative care as “routine follow up,” and considers complications to be outside that definition. As such, the information above pertains only to payers that follow the Medicare complication
LuAnn Jenkins, CPC, CPMA, CEMC, CFPC
By LuAnn Jenkins, CPC, CPMA, CEMC, CFPC http://news.aapc.com/index.php/2011/06/can-we-bill-for-that/
By LuAnn Jenkins, CPC, CPMA, CEMC, CFPC http://news.aapc.com/index.php/2011/09/identical-minor-surgical-procedures-modifier-59-or-units/
By LuAnn Jenkins, CPMA, CPC, CEMC, CFPC