Neurosurgery Coding Alert

Question: I have heard that I should use modifier FT whenever a Medicare patient receives critical care. Is this correct, or have I been misinformed?

AAPC Forum Participant

Answer: You’ve been misinformed. You’ll use modifier FT (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)) for some critical care services, but it isn’t for use on every Medicare patient’s critical care claims. Medicare has been requiring modifier FT in certain situations since Jan. 1, 2022.

When to use: According to Noridian Jurisdiction E – Medicare Part B, modifier FT “is used to report a critical care E/M visit during the global period of a procedure [that] is not related to the operative procedure.” So, if a patient was in the global period for a spinal surgery and then suffered a stroke that required the same neurosurgeon to provide critical care, you’d append modifier FT to 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (… each additional 30 minutes (List separately in addition to code for primary service)), when reported. The rule also applies to other evaluation and management (E/M) codes; so, if the E/M care in the above scenario didn’t merit 99291, you could report the appropriate E/M code with modifier FT appended.

You should also use modifier FT when the physician performs an E/M visit on the same day as another E/M visit. Modifier FT lets Medicare payers know that the E/M services are unrelated to one another.

Per Noridian, correct use of modifier FT means:

• “Critical care requires 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;
• “Critical care services reported on same day as another E/M visit must be provided after the initial E/M service, and before the patient required critical care; and
• “Documentation supports medically reasonable and necessary service for the diagnosis and treatment of illness or injury to improve the functioning of a malformed body member.”

Note: These rules are for Medicare carriers and those who follow Medicare rules. Other payers likely have other rules on reporting these services, and they might prefer modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) in some of the situations described above.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC