Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Modifiers)
11-4
**The impact to payment statements below are a general guide
and not a guarantee of payment**
MOD Description Submission Guidelines Impact to Payment
-22 Increased
Procedural
Services
-24 Unrelated
Evaluation and
Management
(E/M) Service by
the Same
Physician During
a Post-operative
Period.
Note: Blue Cross
defines the
“same
physician” as the
same physician,
or physicians of
the same or
similar specialty
within the same
clinical practice.
Requires submission of an operative
report, narrative and/or other relevant
documentation that adequately describes
what care/service was greater than usually
required.
Do not use modifier –22 when there is an
existing code to describe the service.
By appending the –24 modifier to an
unrelated E/M service you are indicating
that the patient’s condition requires a
significant, separately identifiable E/M
service above and beyond the other service
provided, or beyond the usual preoperative
and post-operative care
associated with the procedure that was
performed. Services appended with a –24
modifier must be sufficiently documented
in the patient’s medical record that the visit
was unrelated to the post-operative care of
the procedure. An ICD-9-CM that clearly
indicates that the reason for the encounter
was different and unrelated to the postoperative
care may provide sufficient
documentation.
Note: Requests to add a modifier -24 to a
denied service must follow the
replacement claim process. An
adjustment request will not be
allowed.
The availability of
additional payment
will be determined
based on review of
supporting
documentation.
Separate payment of
the E/M may be
allowed.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/05/11)