Date Issued: 9/7/2018
A Centers for Medicare & Medicaid Services (CMS) policy states: “Separate payment is not allowed for evaluation and management (E/M) services billed during the postoperative period with modifier 24 (Unrelated E/M by the same physician during a postoperative period) without sufficient indication that the visit is unrelated to the surgery.”
Modifier 24 is intended for use with services that are absolutely unrelated to the surgery; it is not intended to be used for the medical management of a patient by the surgeon following surgery.
Major Procedure
Any evaluation and management services billed with modifier 24 during a major surgical procedure 90-day postoperative period with a complication of surgical and medical care diagnosis or an aftercare diagnosis will be denied.
Minor Procedure
Any evaluation and management services billed with modifier 24 during a minor surgical procedure 10-day postoperative period with a complication of surgical and medical care diagnosis or an aftercare diagnosis will be denied.
