You can perform an X-ray perfectly and still be paid less than expected. This happens when you use an old technology that the Centers for Medicare and Medicaid Services (CMS) discourages, like computed radiography (CR) or cassette-based imaging.
You can get your reimbursement reduced by more than 10% for computed radiography. The question is: if you perform both a CR X-ray and a digital X-ray, how will you differentiate them on a claim?
The answer is the FY modifier. If you want to learn more about this modifier and how it works, keep reading our guide.
FY Modifier – Description
The FY modifier is defined as:
“X-ray taken using computed radiography technology/cassette-based imaging.”
The definition sounds more like that of a CPT code. But it’s not. Let’s discuss what this means.
Computed radiography is an older form of digital X-ray. It works like a film cassette in principle, but the difference is that it produces a digital image. Even though CR produces a digital image, CMS treats it as any other cassette-based imaging.
But why do you need to append this? Well, the Consolidated Appropriations Act of 2016 was passed to move healthcare providers away from older imaging techniques, including CR X-rays. For this, the CMS reduced the reimbursement amount for CR X-rays. That’s why if you perform computed radiography, you must append the FY modifier to tell the payer that the imaging was done via older technology.
The important thing to understand here is that FY does not represent performing the X-ray itself. It just points to the method used for imaging. Also, you cannot charge the patient for the reduced amount.
Scenarios Where the FY Modifier is Applicable
Let’s look at a couple of real-world scenarios in which the FY modifier can be used:
Scenario 1
Suppose a patient comes to a medical practice. He has a persistent cough that isn’t getting better with over-the-counter medications. The attending physician examines the condition and orders a chest X-ray with two views. The practice has its own imaging service. However, it uses an imaging system with cassettes and imaging plates, so the study is a CR X-ray.
The physician interprets the imaging results and provides the necessary treatment. Here, the billing department can use the FY modifier along with the appropriate CPT code to bill the X-ray.
Scenario 2
Let’s look at another scenario. Suppose a man falls while playing football. His wrist becomes swollen, and he feels severe pain. He then visits the nearest orthopedic clinic. The physician orders an X-ray of the wrist. However, the clinic uses an old CR system for imaging. The results are obtained, and the physician finds a clear fracture.
Necessary treatment is provided to the patient. In this case, the billing department can use the FY modifier to indicate that the X-ray was performed on a CR system.
FY Modifier – Billing Guidelines
We have covered the basics. Now, let’s discuss some important guidelines that will help you use modifier FY correctly in your claims. Take a look:
Both CR and DR Images
If you perform an X-ray with both CR and DR methods, and some images are from a CR cassette and the rest come from a DR panel, there won’t be any reduction in the reimbursement amount.
CMS has clarified that if the imaging service combines both methods, then the reduction does not apply.
Know Which Component is Reduced
The reduction applies only to the technical component and the TC of the global fee. The professional interpretation’s payment is not reduced by FY.
You might think that with a 10% reduction and that too only on the technical component, the cut is too small. However, when compounded over hundreds of claims, the amount becomes significant.
Sequence FX and FY Correctly
Some codes may carry both modifiers FX and FY.
In that case, the FX reduction is applied first, and the FY reduction follows.
Conclusion
We have reached the end of this guide. Since there is a lot of information to keep track of, let’s quickly recap the essential points:
- The FY modifier reports an X-ray taken using computed radiography or cassette-based imaging.
- Reimbursement is reduced only for the technical component by 10%.
- FY is not needed for digital radiography, packaged X-rays, or studies that combine CR and DR images.
- Sequence FX before FY.
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