Health Information Management

Q&A: Can we still report a modifier for device credits?

APCs Insider, December 13, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: Will we need to continue appending the modifier when we receive credit for a device from the manufacturer in 2014? We have pacemakers and other devices that are recalled and replaced on occasion and we struggle to get the modifier appended before the claim is billed.

A: The answer to your question is no, the modifiers will not be used in CY 2014 for reporting device credits. But, before you get too excited, you still must report the credit. CMS is changing the reporting from the modifier methodology to a new value code. Value code -FD is defined as “credit received from the manufacturer for a replaced medical device.” Instead of the reporting being based on total or partial credit for a device, the amount of the credit (when it is 50% or more of the cost of the device) will be reported on the claim with value code -FD.

The devices that are subject to this reporting are expensive devices, such as pacemakers, defibrillators, event recorders, neurostimulators, etc. Table 31 in the OPPS final rule provides a complete list of the devices subject to this reporting requirement.

The actual amount of the device credit will be deducted from the APC payment, up to the maximum device offset amount included in the APC payment. If the cost of the device credit is more than the device offset calculated into the APC, CMS will only subtract the amount of the device offset from the payment. Table 30 in the OPPS final rule lists the APCs that are subject to the device offset policy.

The application of modifiers -FB and -FC has been an operational challenge for many facility providers due to the need for timely communication of the information to the appropriate person who appends the modifier. The need for communication will not change or disappear with this new methodology. Each facility should bring the affected parties together to ensure that communication is solid for this process. The OIG has been auditing for the application of modifiers -FB and -FC, and will likely continue to monitor the appropriate reporting and appropriate alteration of APC payment based on the credit received.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular