Append Modifier FT for Unrelated Critical Care Services


On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (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.

While the new modifier took effect Jan. 1, the Centers for Medicare & Medicaid Services (CMS) only recently provided some specifics about its application. Read on to find out what CMS had to say about using modifier FT when billing for separate payment of critical care services provided during, and unrelated to, global surgical procedures.

Take a Closer Look at Modifier FT

Simply put, you should append modifier FT to report an unrelated evaluation and management (E/M) service during the global period of a procedure or on the same day as another E/M service. Doing so indicates that the E/M service performed is not related to either the operative procedure or to the other E/M service provided on that same day.

Unrelated Critical Care Warrants Modifier FT

Patients may require critical care visits during the global period of a procedure, whether preoperative, same day, or during the postoperative period. In some cases, the CPT® codes that have a global surgical period include pre- and postoperative critical care services.

With the release of updated policies in January, CMS provides authoritative guidance explicitly stating that Medicare will allow separate payment for unrelated critical care services furnished on the same day or during the global surgical period. Proper reporting of these services includes appending modifier FT to the critical care CPT® code(s).

The key here is unrelated. For Medicare to cover services described by CPT® codes 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes and +99292 (each additional 30 minutes) — when performed before or after surgery, or on the same day as a procedure — the two services must be distinct and the documentation should demonstrate how they stand alone.

CMS Weighs In

Per the latest guidance, in those cases where a critical care visit is unrelated to the procedure with a global surgical period, critical care visits may be paid separately in addition to the procedure if certain conditions are met. CMS allows payment for preoperative/postoperative critical care “in addition to the procedure if the patient is critically ill (meets the definition of critical care) and requires the full attention of the physician, and the critical care is above and beyond and unrelated to the specific anatomic injury or general surgical procedure performed (for example, trauma, burn cases).” In such cases append modifier FT.

Change Request 12543, released Jan. 14, clarifies that if the surgeon fully transfers care to an intensivist (and the critical care is unrelated), they need to use modifiers 54 Surgical care only and 55 Postoperative management only to indicate the transfer of care. The surgeon reports modifier 54. The intensivist accepting the transfer of care reports both modifier 55 and modifier FT. As usual, medical record documentation must support the claims.

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