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Applying Modifier 24

Applying Modifier 24

Modifier 24 Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period shows that the E/M being billed is not part of the global surgical package and therefore is separately reimbursable. To further indicate that the procedure is unrelated, it is recommended to assign a diagnosis code that is different from the diagnosis code linked to the previous procedure.
For example, on May 1, the patient undergoes an appendectomy for acute appendicitis. The appropriate coding based on this information is 44950 Appendectomy with 540.9 Acute appendicitis; without mention of peritonitis. On May 19, the patient presents to the same operating surgeon with a new onset of right upper quadrant (RUQ) abdominal pain. At this visit, the surgeon examines the patient and suspects cholecystitis. He orders a complete blood count (CBC) and abdominal ultrasound, and documents an expanded problem focused history, expanded problem focused exam, and medical decision-making of low complexity.
The appropriate coding on May 19 is 99213-24 Office or other outpatient visit for the evaluation and management of an established patient with a diagnosis of 789.01 Abdominal pain; right upper quadrant. Modifier 24 is appended to indicate that this E/M is unrelated to the previous surgery (note the use of different diagnoses).
In our next example, it is appropriate for the same diagnosis to be used for both the surgery and the subsequent E/M service: On June 1, the patient presents for a closed treatment of a single metacarpal fracture in his left hand. The appropriate coding is 26600-LT Closed treatment of metacarpal fracture, single; without manipulation, each bone, which has a 90-day global period (the LT Left side modifier is appended to indicate location), with a diagnosis of 815.03 Fracture of metacarpal bone(s); closed; shaft of metacarpal bone(s).
On July 1, the patient presents to the same operating surgeon, complaining of a possible fracture in his right hand. The physician performs an expanded problem focused history and exam and his medical decision-making is of low complexity. After review of the X-rays, which may be separately billable, the physician identifies a fracture. The appropriate coding is 99213-24 Office or other outpatient visit for the evaluation and management of an established patient, with 815.03. Note the use of the same diagnosis.

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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