Be Paid for Modifier 24

If you’re not getting paid for unrelated evaluation and management (E/M) services furnished by the same physician during the postoperative period, you may want to brush up on the guidelines for modifier 24 Unrelated evaluation and management (E/M) service by the same physician during the postoperative period. Medicare administrative contractor (MAC) NHIC, Corp. recently published a new provider education article regarding modifier 24 on its website. A quick review might help you to get those claims paid.
According to the jurisdiction 14 MAC, E/M claims billed with modifier 24 are often denied because the medical record submitted for the E/M service doesn’t support a service unrelated to the original major or minor surgery and/or the signature is illegible. Failing to submit requested supporting documentation (denial reason code N29) is also a common reason for a contractor to deny a claim.
Know this: Jurisdiction 1 MAC, Palmetto GBA, recently posted its top denial reason codes for Medicare Part B claims in June. Denial reason code N29 Documentation requested for this date of service was not received or was incomplete made the top of the list. Providers are encouraged to review the report to prevent similar denials that prevent claims from being processed in a timely manner.
To ensure proper payment of E/M services billed with modifier 24, NHIC, Corp. offers these billing tips:

  • Use of modifier 24 is appropriate with CPT® codes 99201-99499 and 92012-92014.
  • Services submitted with modifier 24 must be sufficiently documented in the medical record to establish that the visit was unrelated to the condition for which the surgery was performed. Do not submit the documentation unless requested to do so.
  • Append modifier 24 to the E/M code performed during a pre- or postoperative period of a procedure performed by the same physician, but which is unrelated to the major or minor surgical procedure performed.
  • When submitting modifier 24 with codes (99291-99292), documentation (a diagnosis is acceptable) that the critical care was unrelated to the specific anatomic injury or general surgical procedure performed must be submitted.

Read the provider education article for examples of supporting documentation and signature requirements.
Tip: Also newly published by NHIC, Corp. are education articles on prepayment probe review findings for diagnostic ultrasound of the abdomen (CPT® 76700), and physicians tips for Medicare record authentication.


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No Responses to “Be Paid for Modifier 24”

  1. Newgenerationbilling says:

    In my experience, you don’t have to submit the supporting documentation with your claim. My claims go electronically, and as long as I have the proper diagnosis and modifiers the claims are usually paid. I do tell my doctors to document everything thoroughly just in case the insurance asks for the office notes, though.