“I have a patient who had a bunionectomy. The patient was diagnosed with a post operative infection within the global period which required evaluation and management. I billed for an office visit, but Medicare will not pay. What am I doing wrong? I used 24 as a modifier.”
In order to bill for an E/M service within the postoperative global period of a CPT/procedure code, whether the postoperative global period is 10 days or 90 days, a modifier must be added to the E/M code that is performed and billed. The modifier is the 24 modifier. The 24 modifier is defined as the following: UNRELATED E/M SERVICE DURING THE POSTOPERATIVE PERIOD – Use this modifier (only on an E/M code) when you perform an Evaluation and Management service during the follow-up period of an unrelated surgical procedure. You are entitled to bill for an E/M service performed during the follow-up period if that service is not related to the original surgical procedure. In this case, add the -24 modifier to the E/M service code. Make sure you reference this service code to the appropriate unrelated diagnosis on the billing claim.
A bunionectomy was performed on a patient. Following the performance of the procedure, a postoperative infection developed within the postoperative global period of 90 days. Despite the fact that the patient needed to be examined and treated during this E/M encounter, since the E/M service that was performed was clearly directly related to the procedure that was performed that set the global period, this would be an incorrect use of the 24 modifier and the E/M service is not covered. That is precisely why the E/M service was not reimbursed. There is not another modifier that can be appended to the E/M service to allow for reimbursement.
This is my opinion.
Michael G. Warshaw, DPM, CPC
**Additional Important Information:
June 28, 2025
Traditional Medicare to Add Prior Authorizations in NJ, OH, OK, TX, AZ, WA.
Medicare will be requiring pre-treatment approvals in its fee-for-service program in a bid to root out unnecessary care, federal regulators announced Friday. The change will apply to 17 items and services, including skin substitutes, deep brain stimulation for Parkinson’s disease, impotence treatment, and arthroscopy for knee osteoarthritis. The program will start January 1, 2026, and run through the end of 2031. It will only apply to providers in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
Overuse of skin substitutes to help heal wounds has especially come under fire in recent years. Medicare spent more than $10 billion on the products in 2024 – more than double what was spent the year before, according to the New York Times. Providers in the geographic areas can choose whether or not they want to submit an authorization request before delivering a service. But if they decide not to, they’ll be subject to post-claim review and risk not getting paid for a service that was already delivered.
Source: Maya Goldman, Axios [6/28/25] via Dr. Seymoure Balaj
THE 2025 PODIATRY CODING MANUAL IS STILL AVAILABLE in either Book or Flash-drive formats. It has been completely updated for the calendar year 2025. Many offices across the country consider this to be their “Bible” when it comes to coding, billing, and documentation. The price is still only 125.00 including shipping! To
purchase, access the website drmikethecoder.com.
No credit card? No problem! Just send a check for 125.00 to the following address:
Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, Florida 32757
Read Comments