Physician Billing: Stay Away from Modifier 24 Myths

If you want to ensure you get paid for services your physician carries out after a major procedure while you are still billing in the global period of the procedure, you need to be well-versed with modifier 24. Even veteran billers fall prey to modifier 24 confusions.

So it's very important that you stay away from these myths – if you are to stay away from the billing trap.

You should only add modifier 24 to a proper evaluation & management code when an evaluation & management service takes place during a postoperative global period for reasons unrelated to the original procedure. Modifier 24 tells the payer that the surgeon is seeing the patient for a just-in problem. As such, the plan shouldn't include the E/M service in the earlier procedure's global surgical package.

This modifier is only for use on E/M codes and only for use during the post-operative period.

Rule: During the global period you can't bill separately for E/M services relating to the original surgery. The global surgical package includes routine postoperative care during the global period.

What's more, modifier 24 also applies to services your physician carries out post the surgical procedure. If your physician carries out an evaluation & management service prior to a procedure on the day of that procedure, you'd need a modifier 25 or the modifier 57.

Do not assume you can't bill separate services using modifier 24

You shouldn't think that just because you cannot bill separate services using this modifier because a patient was slated to come into your office for a follow-up visit related to the surgery.