ENT Modifier 24

Question:

Q: My physician saw a patient three weeks post-op after an adenoidectomy. The patient is complaining of ear pain at this visit. Can I report am E/M service with Modifier 24?

Answer:

According to CPT and Medicare payment rules, an unrelated problem evaluated and managed during the global period is reportable. The unrelated diagnosis is the “key” to reporting the E&M service during the global period. Modifier 24 must be linked to identify the E&M as unrelated to the surgical procedure during the global period.

Verify that there is not a payor-specific rule, for example, that assigns different global days, e.g., 30 days versus 10 days, to the procedure. Appeal all inappropriate denials. Track the pattern of denials by payor to determine if the trend is payor-specific.

*This response is based on the best information available as of 10/31/24.