Description
Unrelated evaluation and management service.

Guidelines/Instructions
  • This modifier may be used to indicate that an evaluation and management (E/M) service or eye exam, which falls within the global period of a major or minor surgery and which is performed by the surgeon, is unrelated to the surgery
    • The global period of a major surgery is the day prior to, day of and 90 days after the surgery. Note that although the CPT description of CPT modifier 24 reflects "postoperative," you may submit this modifier for a visit performed the day prior to a major surgery when the visit is unrelated to the surgery.
    • The global period of a minor surgery is the day of and 10 days after the surgery
  • This modifier may only be submitted with E/M and eye exam codes
  • When this modifier is submitted, supporting documentation in the form of a clearly unrelated diagnosis code and/or additional documentation must be submitted with the claim. See examples below.
    • If the diagnosis for the E/M service clearly substantiates that the visit was unrelated to the surgery, there is no need to submit additional documentation
    • If additional documentation is needed, submit it in the electronic documentation record or as an attachment, for paper claims. Documentation must support that the E/M service is unrelated to the surgery.
  • Special note for ophthalmologists: if the exam and prior surgery were performed on different eyes, indicate this information clearly in the electronic documentation field. HCPCS modifiers RT and LT may not be submitted with eye exam codes.
To determine the global period of a surgery, refer to the Medicare Physician Fee Schedule database (MPFSDB).
  • Access the database directly from the CMS website
  • Select Physician Fee Schedule Search from the bottom of the web page
  • Screen defaults to current year. Under Type of Information, select Payment Policy Indicators.
  • Choose a single procedure code, multiple procedure codes, or a range of codes, then enter the appropriate code(s) 
  • Select modifier (or select "all modifiers")
  • Select Submit 
  • 000 = Endoscopic or minor procedure with related preoperative and postoperative relative value units on the day of the procedure only, included in the fee schedule payment amount. E/M services on the same day of the procedure are generally not payable. For more information about E/M services on the same day as a surgical procedure with 000 global days, refer to CPT modifier 25.
  • 010 = Minor procedure with preoperative relative values on the day of the procedure and postoperative values during a 10-day postoperative period included in the fee schedule amount. E/M services on the day of the procedure and during this 10-day postoperative period are generally not payable. For more information about E/M services on the same day as a surgical procedure with 010 global days, refer to CPT modifier 25.
  • 090 = Major surgery with a 1-day preoperative period and 90-day postoperative period included in the fee schedule payment amount. E/M services on the day before the procedure, the day of the procedure and within the 90-day postoperative period are generally not payable. 
  • MMM = Maternity codes. The usual global period does not apply.
  • XXX = Global concept does not apply
  • YYY = Palmetto GBA will determine whether the global concept applies and establish a postoperative period, if appropriate
  • ZZZ = Code is related to another service ("add-on" code) and is always included in the global period of the other service
Examples of Supporting Documentation:
  • Diagnosis code(s) that are clearly unrelated to the surgery
  • Documentation must be submitted with the claim if the submitted diagnosis code for the visit is not clearly unrelated to the surgery
  • For dates of service on and after October 1, 2015: ICD-10-CM code Z08, Z51.11-Z51.12
  • Documentation indicating "immunosuppressive therapy" for organ transplants
In some situations, as indicated in the following examples, documentation in addition to a diagnosis code may be needed to clearly support the use of CPT modifier 24. Documentation may be submitted in the appropriate documentation record for electronic claims or as an attachment to the CMS-1500 claim form for paper claims.

Examples Requiring Documentation in addition to a diagnosis code include:


Symptoms, nonspecific findings and complication ICD-10-CM diagnosis codes.


Examples
Surgery CPT CodeSurgery DiagnosisVisit Diagnosis
Example 1 66984 (cataract removal) H25.811 (cataract, right eye) H53.141 (visual discomfort, right eye)
Example 2 44950 (appendectomy) K35.20 (acute appendicitis with generalized peritonitis) R10.30 (unspecified abdominal pain)
Example 3 32480 (removal of lung) C34.91 (lung cancer, right lung) J86.9 (lung infection)

ICD-10-CM diagnosis code(s) closely related to or near the surgical area.

ExamplesSurgery CPT CodeSurgery DiagnosisVisit Diagnosis
Example 1 27870 (arthrodesis, ankle) M19.071 (osteoarthritis, right ankle and foot) M12.58 (arthropathy, other specified site)
Example 2 66984 (cataract removal) H25.811 (cataract, right eye) H35.89 (retinal disorders)
Example 3 11440 (lesion excision e.g., eyelid) D23.111 (neoplasm of right eyelid) D23.30 (neoplasm unspecified part of face)
Example 4 44140 (colectomy) C18.3 (cancer, hepatic flexure) K56.609 (intestinal obstruction)

Additional Modifiers May Apply:
  • When a visit occurs on the same day as a surgery with "0" global days and within the global period of another surgery and the visit is unrelated to both surgeries, CPT modifiers 24 and 25 must be submitted
Reference:

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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