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Modifier XE

Separate Encounter: A service that is distinct because it occurred during a separate encounter.

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Modifier XP

Separate Practitioner: A service that is distinct because it was performed by a different practitioner.

Modifier XS

Separate Structure: A service that is distinct because it was performed on a separate organ/structure.

Modifier XU

Unusual Non-Overlapping Service: The use of a service that is distinct because it does not overlap the usual components of the main service.

What is Modifier 59?

Modifier 59 is used to lớn define a “Distinct Procedural Service.” These are procedures and services performed by a healthcare provider that are not typically reported together, but are appropriate & separately billable given the circumstances.

When modifier 59 is appended to lớn a CPT code, it indicates that the service is separate và distinct from another service with which it would usually be bundled. The modifier allows the claim khổng lồ pass Medicare bundling edits, resulting in additional reimbursement for the physician. Modifier 59 can be used to indicate a variety of situations including:

• Different encounters;

• Different anatomic sites; and

• Distinct services.

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It’s also important lớn remember that modifier 59 should not be attached lớn an E/M service.

Why New Modifiers?

Modifier 59 is not only the most used modifier, but it’s also the most abused. & while the abuse may be unintentional at times, the improper coding leads to lớn incorrectly paid claims. As audits have increased, CMS has realized that more specific modifiers may be helpful in deterring this abuse.

The -XEPSU modifiers are essentially a subset of modifier 59. CMS believes their usage will help reduce overpayment errors.

How lớn Use the –XEPSU Modifiers

Modifier 59 is not going away and will continueto be avalid modifier, according toMedicare. However, modifier 59 should NOTbe used when a more appropriate modifier, lượt thích a XE, XP, XS or XUmodifier, is available. Certain codes that are prone lớn incorrect billing may also require one of the new modifiers.

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CMS is encouraging providers khổng lồ adopt the modifiers quickly; they may be used by Medicareand considered valid even before national edits are in place on January 1st.