Medicare regularly updates its modifiers to improve the payment accuracy for medical procedures. In January 2022, it implemented a new FS modifier to appropriately compensate those who provided the medical services.
This modifier helps recognize the services of a physician and a non-physician practitioner (NPP) who were involved in patient care. Even though modifier FS has been in use for quite some time, many billers and coders are still unaware of the accurate uses of this modifier. This lack of understanding leads to inappropriate claim submissions and payment denials.
Here, we will examine the FS modifier and clarify its usage with real-world scenarios in the medical field.
FS Modifier – Description
The FS modifier was introduced by Medicare a few years back. It refers to split or shared evaluation and management (E/M) services. This modifier is used to indicate to the payer that both a physician and an NPP (such as a nurse practitioner or physician assistant) from the same billing group practice worked together to provide an E/M service in a facility setting.
In simple words, modifier FS indicates that an E/M service was shared between two types of providers instead of a single physician providing the complete E/M service.
Appropriate Use Cases for FS Modifier
The following are some examples of applying the FS modifier in the healthcare sector.
E/M Visit at a Hospital
Suppose an older patient is recovering from a hip replacement surgery at a hospital inpatient ward. A certified nurse practitioner (NP) first assesses the patient’s mobility concerns and pain levels and examines the surgical incision. Afterwards, the physician assesses the patient, modifies painkillers, and determines whether more physical therapy is necessary.
In this case, both providers offered their distinct services in the same shared E/M visit. Hence, the service may be billed with the FS modifier.
Critical Care Services
Let’s say a patient in an intensive care unit (ICU) has suffered a cardiac arrest. Stabilizing the patient is the responsibility of a nurse practitioner. He notes the patient’s condition, maintains oxygen levels, and monitors vital signs. In contrast, the physician creates a treatment plan, analyzes lab and imaging data, and offers additional critical care services.
In this case, the entire critical care time of both providers can be combined, and the FS modifier can be used to indicate the shared services. The provider who handled the majority of the care is the one who bills for the service.
Accurate Usage Guidelines for FS Modifier
Here are some essential guidelines to keep in mind while filing claims with the modifier FS.
Include Necessary Documents
Accurate and complete documentation is essential for the billing of an FS modifier. Your paperwork must prove that the two individual practitioners provided services to the same patient on the same day. The physician or a non-physician who performed substantive services (spent more than half the total time or performed the key component) must bill and sign the documents. Furthermore, you must provide:
- A proof indicating that this was a shared/split E/M visit.
- Mention the physician’s and non-physician’s name.
- Total time spent.
- Provide an attestation of the substantive portion.
Append for Appropriate Cases
Correct application is essential for the billing of any modifier. Hence, you must be aware of the accurate use of an FS modifier so that you can secure complete reimbursement for your services.
You can apply this modifier to an E/M service code if the visit took place in an institutional setting, e.g., a hospital or critical care/emergency department. You cannot use modifier FS if the E/M service was performed in an office practice setting or at a skilled nursing facility.
Avoid Inappropriate Uses of Modifier FS
Below, we mention some circumstances where you cannot append an FS modifier.
- Service performed in a non-facility setting, such as an office.
- The E/M service was provided by a single physician.
- The NPP and the physician did not belong to the same group.
- The service is not considered an E/M service.
- Failure to establish a substantive part in the documentation.
If you apply this modifier in the above-discussed cases, Medicare may reject your claim because of non-compliance with the payer’s policies.
Final Thoughts
The FS modifier facilitates compliant billing of split or shared E/M visits in facility settings where both a physician and an NPP provide patient care. Complying with the payer’s rules is essential for its accurate reimbursement.
However, as a biller, you may still have questions about how to properly apply this modifier, or you may be encountering difficulties when invoicing for it. If that’s the case, we recommend NeuraBill’s medical billing and coding services. The company employs a professional team of expert billers and coders who stay abreast of the latest changes in healthcare billing and train themselves to secure accurate reimbursement for their clients.
