“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 Medicare 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.
Now, if a subsequent procedure was performed to appropriately address the postoperative
Infection, it can be billed, but must be appended by the 78 modifier which is defined as the following: UNPLANNED RETURN TO THE OPERATING/PROCEDURE ROOM BY THE SAME PHYSICIAN FOLLOWING INITIAL PROCEDURE FOR A RELATED PROCEDURE DURING THE
POSTOPERATIVE PERIOD (COMPLICATION MODIFIER).
It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure. (For repeat procedures, see modifier 76) (For unrelated procedures see modifier 79)
This is my opinion.
Michael G. Warshaw, DPM, CPC
OMG! 2026 is ACTUALLY HERE!
The New, Exclusive, More Inclusive 2026 PODIATRY CODING MANUAL is Available Immediately in either Book or Flash-drive formats. It has been completely updated for the calendar year 2026. 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