Modifier FTNovember 1st, 2022 - Wyn Staheli
As of January 1, 2022, CMS created a new modifier for an unrelated E/M visit during a postoperative period. It was revised as of April 1, 2022, quite possibly due to some questions on usage. Modifier FT is described as follows
Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated)
The following information about modifier FT can help clarify coding in the following circumstances:
When an E/M service is performed earlier in the day and the provider who performed it (or another provider from the same service, group practice, and specialty) performs a second, unrelated E/M service, the second E/M service is reportable and, based on Medicare policies, may require modifier FT or modifier 25 to indicate that the services are unrelated and that both should be paid.
When an emergency department provider performs an E/M service which results in a patient admission and later in the day the same provider (or another provider in the same service, group practice, and specialty) performs a critical care service, both providers may bill for both services by appending modifier 25 to the critical care service.
Critical care services are sometimes required during the global period of a surgery or procedure (whether preoperatively on the same day, or during the postoperative period). Some CPT code descriptions bundle critical care services into the postoperative global period while others do not. According to CPT and CMS guidelines, as long as the critical care service is unrelated to the procedure performed, it may be separately reimbursed by adding modifier FT. Depending on the specific type of provider and service rendered, consider whether or not modifier 55 (postoperative management only) or modifier 54 (surgical care only) are better suited to the service. In the case where an intensivist accepts the transfer of care postoperatively it may be appropriate to report a combination of all three.
Note: For more information about the changes to critical care services, CLICK HERE.
It should be noted that other payers may have adopted this modifier as well. One payer made the following statement in relation to Medicaid and commercial policies:
Providers may report modifier FT when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated. For instance, this modifier may be used for critical care performed by a surgeon during a global period; however, the critical care must be unrelated to the procedure/surgery done.
Physician Assistants providing unrelated care to a member during a global period must report modifier FT on the unrelated service(s). Unrelated E/M’s performed by the surgeon, or by another physician or other QHP within the same group and/or same specialty and sub-specialty, during the global period may use the 24 or FT modifier to indicate the service was unrelated. If the FT modifier is not appended the service will be rejected as related to the global surgery.
Be sure that patient documentation in these situations clearly describes why this is an unrelated visit in order to support medical necessity.
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