What is Modifier 24

Modifier 24 is a billing code used by healthcare providers to indicate that an unrelated evaluation and management (E&M) service was performed by the same physician, nurse practitioner, or physician assistant during a postoperative period. The use of this modifier is intended to help providers receive proper reimbursement for services that may not be covered by the primary procedure.

For example, a physician may perform a surgical procedure on a patient and then provide follow-up care during the postoperative period. If the physician also performs an E&M service, such as an office visit, during that time, they can use modifier 24 to indicate that the E&M service was not related to the surgical procedure and should be billed separately.

Coding and Use of Modifier 24

Modifier 24 is typically used in conjunction with CPT® codes for E&M services, such as office visits, and can be applied to a variety of specialties. Knowing when to assign modifiers is half the battle. Here are a few examples of how different specialties may use modifier 24 with certain CPT codes:

• Orthopedic Surgery: A patient may have surgery on their knee, and then visit the orthopedic surgeon for a follow-up visit during the postoperative period. In this case, the orthopedic surgeon would use modifier 24 in conjunction with the CPT code for the evaluation and management service.
• Cardiology: A patient may have a cardiac catheterization procedure, and then visit the cardiologist for a follow-up visit during the postoperative care period. In this case, the cardiologist would use assign modifier 24 in conjunction with the EM service CPT code for the office visit.
• Obstetrics and Gynecology: A patient may have a cesarean section, and then visit the obstetrician-gynecologist for a follow-up visit during the postoperative period. In this case, the obstetrician-gynecologist would use modifier 24 in conjunction with the CPT code for the office visit.
• Gastroenterology: A patient may have an endoscopy procedure, and then visit the gastroenterologist for a follow-up visit during the postoperative period. In this case, the gastroenterologist would use modifier 24 in conjunction with the CPT code for the office visit.

It is important to note that the use of modifier 24 is subject to the rules and regulations set by the American Medical Association (“AMA”), the Centers for Medicare and Medicaid Services (CMS) and private payers. Providers should check with the appropriate payer to ensure they are using the modifier correctly and to avoid denied claims.

Modifier 24 and 25 – When Should I use 24 v 25?

Modifiers 24 and 25 are codes used by healthcare providers to indicate that additional services were performed during a patient visit. While both modifiers are used to indicate that an unrelated evaluation and management (E&M) service was performed, they are used in different situations.

Modifier 24 is used to indicate that an unrelated E&M service was performed by the same physician, nurse practitioner, or physician assistant during a postoperative period. This modifier is used to receive proper reimbursement for services that may not be covered by the primary procedure. For example, a physician may perform a surgical procedure on a patient and then provide follow-up care during the postoperative period. If the physician also performs an E&M service, such as an office visit, during that time, they can use modifier 24 to indicate that the E&M service was not related to the surgical procedure and should be billed separately.

Modifier 25, on the other hand, is used to indicate that a significant, separately identifiable E&M service was performed on the same day as a procedure or other service. This modifier is used to indicate that the E&M service was not included in the primary procedure and should be billed separately. For example, a patient may have a diagnostic test, such as a CT scan, and then visit the physician for an E&M service, such as an office visit, on the same day. In this case, the physician would use modifier 25 to indicate that the E&M service was not included in the diagnostic test and should be billed separately.

It’s important to note that the use of modifier 24 and 25 is subject to the rules and regulations set by the Centers for Medicare and Medicaid Services (CMS) and private payers. Providers should check with the appropriate payer to ensure they are using the modifiers correctly and to avoid denied claims.

Here are a few examples of when you would use modifier 24 and 25:

• Modifier 24: A patient has surgery on their knee and then visits the orthopedic surgeon for a follow-up visit during the postoperative period. In this case, the orthopedic surgeon would use modifier 24 in conjunction with the CPT code for the office visit.
• Modifier 25: A patient has a diagnostic test, such as a CT scan, and then visits the radiologist for an interpretation of the test on the same day. In this case, the radiologist would use modifier 25 in conjunction with the CPT code for the interpretation service.
• Modifier 24: A patient has a cardiac catheterization procedure, and then visits the cardiologist for a follow-up visit during the postoperative period. In this case, the cardiologist would use modifier 24 in conjunction with the CPT code for the office visit.
• Modifier 25: A patient has a diagnostic test, such as an MRI, and then visits the radiologist for an interpretation of the test on the same day. In this case, the radiologist would use modifier 25 in conjunction with the CPT code for the interpretation service.

If a patient sees a physician during a postoperative period, it’s important to document the reason for the E&M service and the fact that it was performed during the post-op period. This documentation should be included in the patient’s medical record to support the use of modifier 24. The use of modifier 24 is subject to review by coder and payers, and it is important to ensure the E&M service is medically necessary with a proper icd-10 code (diagnosis code) and that it is not included in the global period.

Part B Medicare and Modifiers 24 and 25:

The use of modifier 24 and 25 are subject to the rules and regulations set by the Centers for Medicare and Medicaid Services (CMS) and private payers. For example, in the case of Medicare Part B, the use of modifier 24 is subject to the regulations set by CMS. It is important for a medical coder or certified professional coder (“CPC”) to check with the appropriate payer to ensure the modifier is used correctly.

In conclusion, modifier 24 is a valuable tool for physicians, nurse practitioners, and physician assistants to receive proper reimbursement for unrelated E&M services performed during a postoperative period. The modifier can be used in a variety of specialties and in conjunction with CPT codes for E&M services. However, it is important to follow the rules and regulations set by CMS and private payers and to document the reason for the E&M service and the fact that it was performed during a postoperative period.

CPT codes, or Current Procedural Terminology codes, allow doctors and medical professionals to report medical services and procedures uniformly, easily, and accurately. Modifiers can be added to CPT codes to describe a procedure further or add extra details. Your OB/GYN practice can benefit from knowing the most updated CPT codes, as shown below for 2023.

Changes to Codes in 2023

The updated CPT codes for 2023, released by the American Medical Association (AMA) at the end of 2022, made a few changes to the current codes. These include establishing one set of evaluation and management services (E/M) guidelines, which should help make coding more streamlined throughout inpatient and outpatient practices. Additionally:

• Level one consultation codes 99241 and 99251 have been deleted
• The code 99281 may not require the presence of a physician or other qualified healthcare professional

Common OB/GYN CPT Codes 2023

The following are the newest CPT codes for common OB/GYN procedures and office visits.

Evaluation and Management

Consultations

The following are newly updated codes and ranges for consultation codes, according to the 2023 AMA guidelines.

• 99242: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making
• 99243: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and a low level of medical decision-making
• 99244: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and a moderate level of medical decision-making
• 99245: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and a high level of medical decision-making

Visits and Evaluations of Problems

• 99201: Problem-focused office visit from new patient
• 99202: Expanded problem-focused office visit from new patient
• 99203: Detailed office visit from new patient
• 99204: Comprehensive office visit from a new patient with a review of 2-9 symptoms
• 99205: Comprehensive office visit from a new patient with a review of 10 or more symptoms
• 99211: Straightforward office visit from established patient
• 99212: Problem-focused office visit from established patient
• 99213: Expanded problem-focused office visit from established patient
• 99214: Detailed office visit from established patient
• 99215: Comprehensive office visit from established patient

Common Birth CPT Codes

• 59400: Routine obstetric care for vaginal delivery (with or without episiotomy and/or forceps), including antepartum and postpartum care
• 59409: Vaginal delivery only
• 59410: Vaginal delivery only, including postpartum care
• 59425: Antepartum care only; 4-6 visits
• 59426: Antepartum care only; 7 or more visits
• 59510: Routine obstetric care for cesarean section delivery, including antepartum and postpartum care
• 59514: Cesarean delivery only
• 59515: Cesarean delivery only, including postpartum care
• 59610: Routine obstetric care for vaginal delivery (with or without episiotomy and/or forceps) after cesarean delivery, including antepartum and postpartum care
• 59612: Vaginal delivery only, after previous cesarean delivery
• 59614: Vaginal delivery only, after previous cesarean delivery; including postpartum care
• 59618: Routine obstetric care for cesarean delivery following attempted vaginal delivery after previous cesarean delivery, including antepartum and postpartum care
• 59620: Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery
• 59622: Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care

Hysterectomy Code Ranges

• 58150-58210: Abdominal hysterectomy codes
• 58260-58291: Vaginal hysterectomy codes
• 58541-58573: Laparoscopic hysterectomy codes

Well Woman Visits

• 99385 well-patient visit for a new patient between the ages of 18-39
• 99386 well-patient visit for a new patient between the ages of 40-64
• 99387 well-patient visit for a new patient age 65 or older
• 99395 well-patient visit for an established patient between the ages of 18-39
• 99396 well-patient visit for an established patient between the ages of 40-64
• 99397 well-patient visit for an established patient age 65 or older
• 99000: office preparation of a specimen for lab analysis and or its transport from the office to the outside testing laboratory (such as a pap smear)

Contraception CPT Codes

• 58300: placement of intrauterine device (IUD)
• 58301: removal of IUD
• 11981: Insertion, non-biodegradable drug delivery implant
• 11982 Removal of non-biodegradable drug delivery implant
• 11983: Removal with reinsertion, non-biodegradable drug delivery implant

Common Ultrasound CPT Codes

• 76857: Ultrasound, pelvic [nonobstetric], real-time with image documentation; limited or follow-up (such as to view the placement of IUD)
• 76830: Ultrasound, transvaginal to assess reproductive organs
• 76831: Ultrasound examination with saline or color flow Dopper to enhance imaging
• 76801: Ultrasound of pregnant uterus during the first trimester of pregnancy using transabdominal approach
• 76805: Ultrasound of pregnant uterus after the first trimester of pregnancy using transabdominal approach
• 76811: Transabdominal ultrasound to examine pregnant fetus with additional examination of fetal anatomy such as the heart rate, amniotic fluid levels, etc.
• 76817: Ultrasound of pregnant uterus and mother using a transvaginal approach

Modifiers

Modifiers help modify CPT codes to add more detail or distinguish between repeat codes.

• 22: Additional or increased services, such as if a woman delivers twins
• 25: Separate evaluation on the same day as another procedure or service
• 91: Repeat tests taken on the same day with different specimens at different times
• 95: Synchronous telemedicine service rendered via real-time Interactive audio and video telecommunications system
• 310: Not vaccinated against COVID-19
• 311: Partly vaccinated against COVID-19
• 39: Indicates any other under-immunized status

Learn more in our OB/GYN medical billing services.