During a recent Medicare administrative contractor’s (MAC’s) probe, modifier 24 – unrelated evaluation and management (E/M) service by the same physician during a postoperative period was found to be billed incorrectly sixty percent of the time. Since modifier 24 has such a high denial rate and the probe showed that over half of the claims were billed incorrectly, there could be more scrutiny by MACs.
Reducing modifier 24 denials:
- When billing modifier 24, make sure that physicians clarify the unrelated E/M service with supporting documentation
- Check patient history for recent or current inpatient status