In medical billing, accuracy and details are immensely important. Modifiers are what give depth to the claims and tell the payers the actual circumstances in which a service was delivered. It can change how a payer reads a claim.
The AM modifier is one of those modifiers. It often seems unnecessary, but it is not. In this guide, we will tell you why that is, when to use it, and how to use it in your claims. By the end of this guide, you will have a good grasp of it. So, let’s start.
AM Modifier – Description
The AM modifier is defined as:
“Physician, team member service.”
AM is actually an HCPCS Level II modifier. It is appended to both HCPCS and CPT codes. In simple terms, when you append this modifier to a claim, it tells the payers that the service being billed was furnished by a physician who was part of a coordinated care team rather than acting as a solo, independent provider.
AM is mostly classified as an informational modifier. This means that it does not, by itself, affect the payment rate the way modifiers, such as 50 or AS, do. So why use it at all? Well, it is used for documentation accuracy, which is just as important as payment accuracy.
Appropriate Use Cases for AM Modifier
The description might not be enough to clear the concept. So, let’s look at a couple of real-world scenarios in which it can be used:
Scenario 1
Suppose a patient is in a hospital and recovering from a stroke. He is currently in a rehabilitation program. The program is being supervised by a team of physicians. The care team includes a physiatrist, a physical therapist, an occupational therapist, and a speech-language pathologist. All of them coordinate with each other.
The physiatrist then performs an evaluation and management (E/M) service.
Now, since the physiatrist provides a physician service that is specifically rendered as part of a recognized interdisciplinary team service, and the payer’s policy requires the AM modifier for that service, AM is appended to the appropriate E/M code.
Scenario 2
Suppose that a 12-year-old female presents at a pediatric neuropsychiatric clinic for complex neurobehavioral review. She is enrolled in an intensive interdisciplinary care coordination program managed by a team that includes a pediatric psychiatrist, a clinical psychologist, a licensed social worker, and an educational specialist.
During a scheduled 45-minute interdisciplinary care session with the patient and her family, the team members jointly review her behavioral telemetry, medication compliance, and educational accommodation reports. The pediatric psychiatrist leads the session, evaluates the patient, reviews psychiatric components of the team’s recommendations, and updates the medication regimen.
Here, as per the patient’s commercial payer policy requiring modifier identification for interdisciplinary physician services, the AM modifier is appended to the primary physician CPT code.
Accurate Usage Guidelines for AM Modifier
Here are some additional guidelines that will help you use the AM modifier correctly:
Maintain Clear Documentation
Like all modifiers and codes in medical billing, documentation is important for AM to be valid. The documents you attach must clearly show the actual structure of the care team. It should also tell what role the physician played.
Vague notes like “seen by team” won’t work. You have to be detailed and descriptive. Documents should also underscore the nature of the coordination and how the physician’s contribution is distinct from the contributions of other professionals on the case.
Sequence Modifiers Correctly
The sequence of appending the modifiers to the claim is very important. If you have used all the correct modifiers, but their sequencing is wrong, the claims will be rejected. We have already mentioned that modifier AM is an informational modifier.
So, if the AM modifier is being reported alongside a pricing modifier, such as one that affects reimbursement directly, place the pricing modifier first.
Check the Payer Policy on AM
Modifier AM is interpreted differently by different payers. For instance, Medicare accepts its usage if the service was furnished in a skilled nursing facility (SNF) or nursing facility (NF) setting, whereas ForwardHealth wants it to be used with code 97156 only, and when documentation supports that a team meeting was performed.
Final Thoughts on AM Modifier
Let’s wrap up this guide. Here are the key points to remember about modifier AM:
- AM modifier indicates that a service was performed by a physician acting as a team member.
- It is an informational modifier and does not change the reimbursement amount.
- Appending detailed documentation is vital.
- Also, always use the correct sequence of modifiers on the claim.
If your practice needs expert medical billing and coding services, our team at NeuraBill can provide that. We can help you apply modifiers correctly, reduce denials, and keep your revenue cycle running smoothly.
