Understanding X Modifiers

Modifier 59 is used to identify procedures and services that are not typically performed together but are appropriate to bundle under certain circumstances.  There has been growing concern that modifier 59 is both overused and misused, on January 1, 2015, CMS implemented four new modifiers to add clarity to modifier -59, distinct procedural service.

CMS is not removing modifier 59, but instead reminding providers that this modifier should not be used when there is a more descriptive modifier available. These new modifiers will provide a clearer picture of what occurred in the encounter.  Modifier 59 has been described as the “catch-all” modifier to ensure any NCCI edit is overridden. This practice must be addressed, and the new modifiers will prevent this catch-all process.

The new modifiers, commonly called, -X{EPSU} are as follows:

  • -XE, separate encounter, a service that is distinct because it occurred during a separate encounter
  • -XS, separate structure, a service that is distinct because it was performed on a separate organ/structure
  • -XP, separate practitioner, a service that is distinct because it was performed by a different practitioner
  • -XU, unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

The addition of these modifiers should assist in a reduction of -59 modifier claim reviews. This modifier is one of the most common targets for payer audits and has been listed on the Office of Inspector General’s (OIG) work plan for over 10 years. Utilizing these modifiers will provide additional specificity clarifying the need for separate reimbursement for services.

T-System reached out to all RevCycle+ clients to address any concerns and ensure clients that our Advanced Coding System (ACS) was ready to send these modifiers on January 1, 2015.  Our education department has provided training to our global workforce regarding the scenarios where the new modifiers are to be appended.

T-System clients will see the most changes in the area of injection and infusion reporting.  When an injection or infusion procedure code is charged in addition to a CT, modifier -59 would be appended to indicate that the IV and CT are not related.  With the new modifier changes, -XU will be appended instead of modifier 59.  Our account management team will work with our clients on any issues appending this modifier.

Additional information pertaining to these modifiers may be found in CMS Transmittal 1422, Change Request 8863.

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About the Author

Jeannie Ruch, RHIA,CPC, Director of Coding Quality

With over 22 years of healthcare experience, Jeannie Ruch utilizes her expertise in operations, process improvement and auditing to drive quality and education for T-System’s charge capture and coding business. She is also instrumental in the development of T-System’s encoder tool and ICD-10 readiness services. Jeannie attended the American Health Information Management Association (AHIMA) Academy for ICD-10-CM and ICD-10-PCS and is an AHIMA-approved ICD-10-CM and ICD-10-PCS trainer.

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