Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period. Medicare defines same physician as physicians in the same group practice who are of the same specialty.

For example, a patient had cataract surgery on the right eye in August 2021. The procedure has a 90 day global period, so all visits relating to the cataract surgery are included in the surgery payment. In September 2021, the patient returns to have a cyst looked at in the left eye. Report the E&M code with modifier -24 attached to the exam with the diagnosis for the cyst as the reason for the exam.

It’s better to be conservative in using modifier -24. Another thing to note: do not use modifier – 24 for the removal of sutures. Suture removal is included in the procedure payment.

QUESTIONS ABOUT OPHTHALMOLOGY BILLING?

Eye Med Management has over 40 years of experience billing for practices throughout the United States. Contact us today to learn more about our services.