The -X {EPSU} modifiers are shown below but have not yet been well defined by Medicare. 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
When to use Xu modifier and examples?
before the next service begins), you may use modifiers 59 or –XE to identify the services. (See example 9 below.) B. Using modifiers 59 or –XU properly for a diagnostic procedure which is performed before a therapeutic procedure only when the diagnostic procedure is the basis for performing the therapeutic procedure.
When to use XE modifier?
Modifier -XE is used to indicate a separate surgical operative session on the same date of service or a distinct encounter after the patient has left the hospital or changed status or locations within the facility. Example: 8 a.m. outpatient surgery and 8 p.m. outpatient surgery.
When to use XE, XP, XS, Xu modifiers?
Modifiers 59, XE, XP, XS, XU; Distinct Procedural Service
- Definitions. A two-position numeric code that indicates a procedure or service is distinct or independent from other non-Evaluation and Management (E&M) services performed on the same day.
- Policy statement. Codes submitted with modifier 59, XE, XP, XS, or XU attached are considered appropriate coding to the extent they comply with the above definitions.
- References. American Medical Association. Appendix A – Modifiers. Current Procedural Terminology (CPT) Chicago: AMA Press 2013.
When to use the GY modifier with Medicare?
- Vaccines and their administration (not a benefit category)
- Services ordered by naturopaths (not a benefit category)
- Self-administered drugs (statutorily excluded)
- Lab tests with any of the DX noted in the NCD or with an encounter coded with V70.0 (per NCD manual and statutorily-excluded)
- Refraction testing (statutorily excluded)
What is an ex modifier?
Modifier XE Separate encounter – A service that is distinct because it occurred during a separate encounter. Modifier XP Separate practitioner – A service that is distinct because it was performed by a different practitioner.
When should Xu modifier be used?
Modifier -XU is a subset of modifier -59. It can be used to indicate a diagnostic procedure was distinct from an interventional procedure on the same date of service, if it is not a repeat or guiding study. Below example will give clear picture about using XU modifier.
What are the new modifiers for 2020?
Beginning in 2020, Medicare is requiring claims to include new modifiers showing when therapy is provided by a PTA or COTA. The PTA modifier is CQ and the COTA modifier is CO. (The GP, GO and KX modifiers will continue to be required.)
What does GX modifier mean for Medicare?
Modifier GX The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.
Does Medicare cover modifier Xu?
Medicare recently announced they've established four new modifiers – XE, XS, XP, and XU – that may be used in lieu of modifier 59. The codes are more specific and become effective January 1, 2015.
Which modifier goes first 50 or 59?
The first pair of codes in Table C relate to the example previously reviewed. In this example, the procedures were performed on different sites, so the use of modifier 59 is correct.
What is XS modifier mean?
Modifiers 59 or –XS are for surgical procedures, non-surgical therapeutic procedures, or diagnostic. procedures that: • Are performed at different anatomic sites, • Aren't ordinarily performed or encountered on the same day, and.
What is the XE modifier used for?
XE – “Separate encounter, A service that is distinct because it occurred during a separate encounter” This modifier should only be used to describe separate encounters on the same date of service.
What is a GQ modifier?
GQ – Via asynchronous telecommunications system (e.g., 99201-GQ) Use of the GQ modifier certifies an asynchronous telecommunications system was used, such as Store and Forward technologies, to transmit medical or behavioral health information to the provider at the “distant site.”
What is the difference between GA and GX modifier?
Modifier Modifier Definition Modifier GA Waiver of Liability Statement Issued as Required by Payer Policy. Modifier GX Notice of Liability Issued, Voluntary Under Payer Policy. Modifier GY Notice of Liability Not Issued, Not Required Under Payer Policy.
Do G codes need modifiers?
For each non-payable G-code reported, a modifier must be used to report the severity level for that functional limitation. The severity modifiers reflect the beneficiary's percentage of functional impairment as determined by the providers or practitioners furnishing the therapy services.
What is G1 modifier?
Modifier G6 is used for patients who have received dialysis six days or fewer in month. Modifier. Description. G1. Most recent Urea Reduction Ration (URR) reading of less than 60%
What modifiers are used in lieu of 59?
Medicare recently announced they’ve established four new modifiers – XE, XS, XP, and XU – that may be used in lieu of modifier 59. The codes are more specific and become effective January 1, 2015.
What is modifier 59?
Modifier 59 is used to define a “Distinct Procedural Service.”. These are procedures and services performed by a healthcare provider that are not typically reported together, but are appropriate and separately billable given the circumstances.
Is 59 a valid modifier?
How to Use the –X {EPSU} Modifiers. Modifier 59 is not going away and will continue to be a valid modifier, according to Medicare. However, modifier 59 should NOT be used when a more appropriate modifier, like a XE, XP, XS or XU modifier, is available. Certain codes that are prone to incorrect billing may also require one of the new modifiers.
What modifiers are used for 11100?
If the procedures are performed on different sides of the body, modifiers RT and LT or another pair of anatomic modifiers should be used.
When to report modifier 59?
Modifier 59 may be reported if, later in the day following the insertion of a chest tube, the patient develops a high fever and a chest x-ray is performed to rule out pneumonia. Modifier 59 should not be reported with 71020 for a chest x-ray performed following insertion of a chest tube.
What is the difference between XE and XS?
XE – “Separate encounter, A service that is distinct because it occurred during a separate encounter” This modifier should only be used to describe separate encounters on the same date of service. XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure”.
Can modifier 59 be used with 29820?
Modifier 59 should not be reported with 29820 if both procedures are performed on the same shoulder during the same operative session because the shoulder joint is a single anatomic structure. If the procedures were performed on different shoulders, modifiers RT and LT should be used.
What is modifier 59?
Modifier 59 is the most widely used HCPCS modifier. This modifier is associated with considerable misuse and high levels of manual audit activity, leading to reviews, appeals, and even civil fraud and abuse cases. The introduction of four ‘X’ subset modifiers is designed to reduce the improper use of modifier 59 and help to improve and speed up claims processing for providers.
Is XU 59 a diagnostic procedure?
Depending upon your specific circumstances XU or 59 may be most appropriate. A diagnostic procedure is performed. Due to the findings, a decision is then made to perform a therapeutic/surgical procedure. (This may or may not occur in the same procedure room during the same session/encounter.)
Is 20550 a modifier?
The different anatomical sites and contralateral structure. (Note: 20550 is not eligible for modifiers LT or RT.) Separate injury (or area of injury in extensive injuries). Depending upon your specific circumstances XS or 59 may be most appropriate.
Is there a modifier for two physicians?
There is NO other appropriate modifier. NOTE: Two physicians in the same group, with the same specialty, performing services for the same patient on the same day, are considered to be the same physician by Medicare.
Does NCCI include treatment of contiguous structures?
However, it does not include the treatment of contiguous structures of the same organ.
What is a modifier in coding?
Modifiers provide a way to indicate that the service or procedure has been altered by some specific circumstance, but has not been changed in definition or code. Modifiers are intended to communicate specific information about a certain service or procedure that is not already contained in the code definition itself.
What is a CPT modifier?
Modifiers are two-character suffixes (alpha and/or numeric) that are attached to a procedure code. CPT modifiers are defined by the American Medical Association (AMA). HCPCS Level II modifiers are defined by the Centers for Medicare and Medicaid Services (CMS).
What to do if there is no code or combination of codes or modifiers to accurately report the service that was performed
If there is no code or combination of codes or modifier (s) to accurately report the service that was performed, provide written documentation and use the unlisted code closest to the section which resembles the type of service provided to report the service.
Does modifier 59 require a different diagnosis?
“Use of modifier 59 to indicate different procedures/surgeries does not require a different diagnosis for each HCPCS/CPT coded procedure/surgery. Additionally, different diagnoses are not adequate criteria for use of modifier 59. The HCPCS/CPT codes remain bundled unless the procedures/surgeries are performed at different anatomic sites or separate patient encounters.” 2
Is modifer 59 appropriate?
modifer 59. Depending upon your specific circumstances XS or 59 may be most appropriate. A diagnostic procedure is performed. Due to the findings, a decision is then made to perform a therapeutic/surgical procedure. (This may or may not occur in the same procedure room during the same session/encounter.)
Can you bypass NCCI edit?
If the Medicare program imposes restrictions on the use of a modifier, the modifier may only be used to bypass an NCCI edit if the Medicare restrictions are fulfilled.”. “Modifier 59 and other NCCI-associated modifiers should NOT be used to bypass an NCCI edit unless the proper criteria for use of the modifier are met.
What is modifier 59?
This means that if modifier 59 is put on the Column 1 code, the unbundling meant to take place by using modifier 59 (or XE, XS, XP, or XU) does not happen.#N#Click here for case studies on how to use the X [EPSU] modifiers correctly.
When is modifier 59 used?
Effective July 1, 2019, CMS carriers will process modifier 59 when it is used on either the column 1 procedure or the column 2 procedure. The CCI bundling edit will be bypassed when modifier 59, XE, XS, XP, or XU is used on column 1 and column 2 codes.
Does modifier 59 affect Medicare?
Also, the policy change does not affect your Medicare Managed Care payers, Medicaid, or your commercial payers. Survey all of these payers to find out if they have any limitations when applying modifier 59 where it comes to the Column 1 and Column 2 codes. While performing your survey, you might also want to ask your payers if they recognize ...
Four New Modifiers to Use Instead of Modifier 59 – Xe, XS, XP & Xu
What Is Modifier 59?
- Modifier 59 is used to define a “Distinct Procedural Service.” These are procedures and services performed by a healthcare provider that are not typically reported together, but are appropriate and separately billable given the circumstances. When modifier 59 is appended to a CPT code, it indicates that the service is separate and distinct from another service with which it would usual…
Why New Modifiers?
- Modifier 59 is not only the most used modifier, but it’s also the most abused. And while the abuse may be unintentional at times, the improper coding leads to incorrectly paid claims. As audits have increased, CMS has realized that more specific modifiers may be helpful in deterring this abuse. The -X{EPSU} modifiers are essentially a subset of modifier 59. CMS believes their usag…
How to Use The –X{EPSU} Modifiers
- Modifier 59 is not going away and will continue to be a valid modifier, according to Medicare. However, modifier 59 should NOTbe used when a more appropriate modifier, like a XE, XP, XS or XU modifier, is available. Certain codes that are prone to incorrect billing may also require one of the new modifiers. CMS is encouraging providers to adopt the modifiers quickly; they may be us…
Additional Information
- Medicare Learning Network: MLM MM8863 Manual System: Transmittal 1422 Here is a link to my other post with some examples of how to use the new modifiers. CLICK FOR MODIFIER EXAMPLES Still confused? Feel free to ask questions in the comments and we’ll do our best to answer!