ED Coding & Reimbursement Alert - 2017 Issue 8
Reader Question: Find Out When to Append Modifier 24
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Article Overview
This reader question and answer article reviews when a postoperative evaluation and management visit may be considered for modifier 24, along with a related scenario involving return to the operating room and another modifier used in postoperative circumstances. It is aimed at coders, billers, and compliance staff who handle global surgery-period claims, documentation review, and postoperative visit reporting. The discussion focuses on general requirements, common situations to avoid, and documentation considerations under MAC guidance.
Why This Topic Matters
Postoperative visits can affect whether an E/M service is separately reportable, so understanding the boundaries of modifier use helps support compliant claim submission and documentation review.
Article Sections
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Question
A reader asks about billing a hospital E/M visit during a postoperative global period after a return to the operating room.
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Answer
The response addresses postoperative E/M reporting concepts, documentation expectations, and a related postoperative modifier scenario discussed in MAC guidance.
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When you report modifier 24, the E/M service must meet the following requirements:
This section outlines general conditions tied to postoperative E/M reporting and documentation support for unrelated services.
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According to the MAC Noridian, you should never use modifier 24 in the following situations:
This section summarizes categories of postoperative situations identified by MAC guidance as inappropriate for the modifier.
What You Will Learn
- How postoperative E/M services are discussed in relation to global surgery periods
- What kinds of documentation are emphasized for postoperative visit reporting
- How MAC guidance addresses common postoperative scenarios
- How a return-to-OR situation is described in relation to postoperative billing
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Practice managers
- Auditors
Modifiers Discussed
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