On this page
- What Is Modifier 24?
- When Does Modifier 24 Apply in Eye Care?
- What Does Not Qualify for Modifier 24?
- What Should the Claim and Record Show?
- How Long Do Eye Surgery Global Periods Last?
- Does Modifier 24 Apply in Cataract Co-Management?
- What Does a Modifier 24 Claim Look Like?
- How Do Practices Use Modifier 24 Safely?
Key takeaways
- Modifier 24 is used only with E/M and eye exam codes during a surgical global period.
- The visit must be for a problem unrelated to the surgery, by the same provider or group.
- Routine post-op visits and treatment of surgical complications are not billed with modifier 24.
- The diagnosis on the claim should show the visit was for a different problem.
What Is Modifier 24?
Modifier 24 is a CPT modifier for an E/M or eye exam service, during the postoperative period of a procedure, that is unrelated to that procedure. It tells the payer the visit is not routine post-op care, so the visit is paid on top of the surgery.
The modifier only applies to visits by the same physician or group that performed the surgery, because only their visits fall inside the global package.
When Does Modifier 24 Apply in Eye Care?
Modifier 24 applies when a patient in the global period of eye surgery is seen for a different problem, either in the other eye or in an unaffected part of the operated eye. The 90 days after cataract surgery are the most common setting.
The table shows common eye care visits after surgery and whether modifier 24 usually fits.
| Visit during the global period | Modifier 24? |
|---|---|
| Routine one-week check after cataract surgery | No, part of the global package |
| New red eye or infection in the fellow eye | Usually yes |
| Glaucoma follow-up that is not affected by the surgery | Often yes, if documented as unrelated |
| Raised eye pressure caused by the surgery | No, treated as part of post-op care |
| Diabetic eye exam unrelated to the surgery | Usually yes |
The deciding question is whether the problem would have needed a visit even without the surgery. If yes, modifier 24 usually applies.
What Does Not Qualify for Modifier 24?
Routine post-op visits, treatment of a complication that does not need surgery and visits outside the global period do not qualify for modifier 24. These are the four most common misuses.
- Scheduled post-op checks, which are always part of the global package
- Treating a complication of the surgery in the office
- A visit on the day of surgery, which uses modifier 25 or modifier 57 instead
- A visit after the global period has ended, which needs no modifier
A return to the operating room for a complication is a procedure, not a visit, and uses modifier 78, while an unrelated procedure uses modifier 79.
What Should the Claim and Record Show?
The claim should carry a diagnosis for the unrelated problem, and the record should state why the visit was not related to the surgery. Payers deny modifier 24 claims when the diagnosis matches the surgery.
These steps keep a modifier 24 claim clean.
- Diagnosis first. List the unrelated diagnosis as the primary reason for the visit.
- State the reason. Note in the record why the visit is unrelated to the surgery.
- Name the eye. Record which eye was examined and which eye had surgery.
- Check the dates. Confirm the visit falls inside the global period.
How Long Do Eye Surgery Global Periods Last?
Eye surgery global periods last 0, 10 or 90 days, and modifier 24 only matters for visits inside one of them. The global period of the surgery decides how long routine visits stay bundled.
| Global period | What it covers | Eye care examples |
|---|---|---|
| 0 days | The day of the procedure only | Intravitreal injection 67028 |
| 10 days | The day of the procedure and 10 days after | Punctal plugs 68761, laser trabeculoplasty 65855 |
| 90 days | The day before, the day of and 90 days after | Cataract surgery 66984, YAG capsulotomy 66821, vitrectomy 67036 |
A visit after the global period ends needs no modifier. Check the current fee schedule for each code, because global periods can change.
Does Modifier 24 Apply in Cataract Co-Management?
Yes. When an optometrist bills postoperative care with modifier 55, routine post-op visits are part of that care, and an unrelated visit during the same period uses modifier 24. The same rule applies to the surgeon before care is transferred.
The surgeon bills the surgery with modifier 54, and the co-managing doctor bills the post-op share with modifier 55 once care is transferred. Any visit for a different problem, by either doctor, is billed separately with modifier 24 and its own diagnosis.
Can RT or LT be added to the eye exam code?
Not usually. Medicare contractors such as Noridian do not accept RT or LT on eye exam codes. Record which eye was examined and which eye had surgery in the notes and, where the payer asks for it, in the claim's narrative field.
What Does a Modifier 24 Claim Look Like?
A modifier 24 claim bills the exam code with modifier 24 and lists the unrelated diagnosis first. The example shows a patient seen for a new problem three weeks after right eye cataract surgery.
| Claim detail | Example |
|---|---|
| Procedure line | 92012-24 |
| Primary diagnosis | Acute conjunctivitis of the left eye |
| Record note | New red, irritated left eye, unrelated to right eye cataract surgery |
If the primary diagnosis were the cataract or a post-op finding, the payer would bundle the visit into the surgery.
How Do Practices Use Modifier 24 Safely?
Track every visit inside a global period, and let a coder decide on modifier 24 before the claim is sent. Missed modifier 24 visits are unpaid work, and overused ones draw payer review.
Our cataract surgery billing team tracks each patient's global period dates, and our ophthalmology medical coding services check every post-op visit for 24, 78 and 79.