The medical sector is being overtaken by technology as the world evolves. The latest medical instruments are being introduced, and digital radiography (DR) is a new and effective method of performing X-rays.
However, what happens if a medical facility continues to use computed radiography (CR), an old method of performing X-rays? How are they going to bill for their services? In these situations, the healthcare practices take help from modifiers.
Modifier FY is used to inform the payer that an X-ray was performed using computed radiography. Let’s learn about the correct applications of this modifier.
Modifier FY – Description
The FY modifier is a HCPCS Level II modifier that is used to describe:
“Imaging services that are X-rays taken using computed radiography (CR) rather than digital radiography (DR). “
To put it simply, although DR is an advanced X-ray technique, some small practices still use CR because it is more adaptable and cost-effective.
However, the Centers for Medicare & Medicaid Services (CMS) has established guidelines and procedures to apply modifier FY to reduce the use of outdated imaging techniques and encourage providers to switch to the DR system.
Appropriate Use Cases for Modifier FY
Here are appropriate use cases for modifier FY in radiology billing, explained through detailed, realistic scenarios:
Chest X-Ray for Heavy Cough
Let’s say a patient comes to a nearby medical facility complaining of a persistent cough and dyspnea. To rule out lung abnormalities or infection, the physician orders a chest X-ray.
A technician performs the X-ray using computed radiography equipment. In this case, the billing team needs to bill their services with the correct X-ray CPT code and modifier FY appended to it. The FY modifier will explain to the payer that computed radiography was used for imaging instead of digital radiography.
Emergency Room X-Ray
In another scenario, suppose a patient is taken to the hospital’s emergency room after a serious road accident. The attending physician suspects a rib fracture, so he immediately orders an X-ray.
The hospital’s radiology department is still using outdated CR technology for X-rays, although it is gradually switching to the newest imaging systems. To highlight the use of outdated imaging equipment, the hospital’s billing staff must add the modifier FY to the X-ray CPT code on the UB-04 claim form.
X-Ray for Orthopedic Evaluation
Let’s say a resident of a rural location goes to the closest medical facility with a fractured knee. The medical professional takes an X-ray of the knee to evaluate the intensity of the fracture.
Due to financial constraints, the facility still uses computed radiography systems, which use a reusable cassette containing a Photostimulable Phosphor (PSP) plate to generate images instead of contemporary digital radiography.
Therefore, in this particular case, the facility’s billing staff must report modifier FY when filing the claim.
Accurate Usage Guidelines for Modifier FY
Let’s examine the proper applications of the modifier FY as well as the instances when it should not be used.
Correct Use of Modifier FY
FY is appended to an X-ray CPT code when it is performed using CR or a cassette-based imaging system. You cannot apply this modifier to bill an X-ray performed using digital radiography.
This modifier helps the payer understand the type of X-ray system used during the procedure and decide the reimbursement rate accordingly. CMS mandates that the FY modifier be used to report relevant radiology services.
Incorrect Use of Modifier FY
This modifier should not be used when an X-ray is performed using the DR technique. Additionally, you are not required to append this modifier if the payer does not require the proper reporting of the X-ray technology used.
Impact of Modifier FY
The FY modifier became effective for X-ray services rendered on or after January 1, 2018.
CMS implements regulations for computed radiography. This step was taken to wind down outdated imaging techniques used in healthcare facilities. It supports medical professionals and practices to adopt the latest imaging techniques, such as digital radiography.
Additionally, when the FY modifier is appended to a claim, Medicare reduces the payment for the technical component by up to 20%. Therefore, billers must calculate their reimbursement accordingly and expect reduced payments.
Final Thoughts
In today’s guide, we learned that computed radiography X-rays are specifically highlighted to the payer by appending the modifier FY to the relevant CPT codes. Billers must add this modifier to ensure they receive fair reimbursement from payers, including CMS. It encourages transparency between the biller and the payer.
Also, failure to comply with the payer requirements and guidelines may result in denials or other compliance issues. Note that we have also covered the situations where you cannot apply this modifier.
Hence, after this comprehensive guide, if you are still confused about the correct application of modifier FY, we suggest that you opt for professional medical billing and coding services from NeuraBill.
