Why it matters in orthopedics
Orthopedic patients often have more than one musculoskeletal problem. A patient recovering from a knee arthroscopy may develop shoulder pain, or a joint replacement patient may need care for an unrelated hand complaint, while the first procedure’s global period is still running. Medicare includes the surgeon’s postoperative visits in the global surgical package, so an E/M in that window is denied unless the claim shows it was unrelated.
The rule also reaches partners. CMS treats providers of the same specialty in the same group practice as a single physician for global surgery, so a colleague’s unrelated visit during your global period needs modifier 24 too.
How it works
Append 24 to the E/M when a visit during a 10- or 90-day postoperative period is unrelated to the surgery (Medicare Claims Processing Manual, Chapter 12, §40.2.A.7).
Visits for recovery, complications that do not need a return to the operating room, wound care, suture or cast removal, and the surgeon’s postsurgical pain management are part of the global package. They are not billed with 24 (§40.1.A).
The record must show the visit was unrelated. The manual accepts a diagnosis code that clearly shows an unrelated reason for the encounter, and CMS’s global surgery booklet (MLN907166, December 2025) says you must be able to send documentation supporting the unrelated service.
Medicare generally recognizes 24 only for care after discharge. Hospital visits during the stay in which the surgery occurred are paid only if the surgeon treats a separate, unrelated condition (§30.6.6.A and §40.4.A).
If the unrelated E/M happens on the same day as another procedure, CMS’s booklet calls for modifiers 24 and 25 together.
Orthopedic example
A 62-year-old established patient is three weeks out from a right knee arthroscopy and returns to the same surgeon with new left shoulder pain after lifting. The surgeon takes a history, examines the shoulder, reviews X-rays and starts a treatment plan. The practice bills the E/M with modifier 24 and links it to the shoulder diagnosis.
If the surgeon also injects the left shoulder that day, the E/M carries modifiers 24 and 25, and the injection carries modifier 79 with LT. Medicare denies a procedure with its own global period performed during another procedure’s postoperative period unless it carries modifier 58, 78 or 79 (§40.4.A). Our injection-day guide walks through similar same-day cases.
Common denial triggers
The visit’s diagnosis matches the surgical diagnosis, such as knee osteoarthritis after a knee procedure.
Modifier 24 is used for wound checks, suture removal, postoperative pain or a complication that did not require a return to the operating room.
A same-specialty partner bills an unrelated visit during the global period without 24.
24 is used on hospital visits during the surgical admission.
A procedure is billed the same day, but the E/M has 24 without 25.
Medicare remittances for visits bundled into a global package typically show group code CO with CARC 97 (Claims Processing Manual §40.4.D).
How to prevent or fix
Flag patients in an active global period in your practice management system before visits are coded.
Ask providers to state why the visit is unrelated to the surgery, and link the unrelated diagnosis to the E/M.
If a truly unrelated visit is denied, correct the claim or appeal with the note. If the visit was postoperative care, the denial stands.
Check commercial rules too. UnitedHealthcare’s Global Days Policy (2026R0005E, version dated September 20, 2026) also uses modifier 24 for unrelated E/M during the postoperative period. Our guide to common orthopedic claim denials covers related patterns.
Frequently asked questions
Can modifier 24 be used for a complication of the surgery?
Not for Medicare. Medicare’s global surgical package includes the additional medical or surgical services the surgeon provides for complications that do not require a return to the operating room, so those visits are not separately payable with modifier 24. If a complication does require a return to the operating room, the procedure is billed with modifier 78 instead. Check each commercial payer’s global policy for its own rules.
Does a partner in the same group need modifier 24?
Yes, if the partner has the same specialty. CMS treats providers of the same specialty in the same group practice as one physician for global surgery, and UnitedHealthcare applies the same rule to same-specialty physicians under one tax ID. A physician of a different specialty in the same group is not part of the surgeon’s global package, so that physician’s visits do not need modifier 24.
Is modifier 24 needed after a procedure with a 0-day global period?
No. A 0-day global period covers only the day of the procedure, and Medicare pays visits after that day separately without a modifier. A separately identifiable E/M on the same day as a 0-day procedure, such as a joint injection, takes modifier 25 instead of modifier 24.
Guides that cover this term
Can You Bill an E/M With Modifier 25 on an Orthopedic Injection Day?
Medicare rules, payer policies and a scenario table for billing a same-day E/M with modifier 25 alongside knee, shoulder and hip injections.
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The Most Common Orthopedic Claim Denials in 2026, and How to Prevent Them
Ten orthopedic denial types, the CARCs behind them, their root causes and how to prevent them, plus when to appeal or correct and resubmit.
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Related terms
Sources
Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners — CMS, Rev. 13753, issued May 7, 2026
Global Surgery (MLN907166) — CMS Medicare Learning Network, December 2025
Medicare NCCI Policy Manual, Chapter I: General Correct Coding Policies — CMS, revision date January 1, 2026
Global Days Policy, Professional (Policy Number 2026R0005E) — UnitedHealthcare Commercial and Individual Exchange, version dated September 20, 2026
This entry is educational and is not legal, coding-compliance or billing advice. Payer rules change often, so confirm requirements with the payer before you bill. CPT® is a registered trademark of the American Medical Association; code descriptions here are Rette’s plain-language summaries.