Hopefully your office was well aware of the changes that pertain to your specialty well before January 1st, 2015. Offices that aren’t proactive in regards to updating their codes are most likely finding out now with the return of their EOBs, that something was missed.
I can’t stress enough how important it is to have correct coding references in the office available at all times. If you have remote coders and billers, ensure that they have books and/or online resources available. Also, make sure that the sources are reliable. I have come across many online or subscription aps that are not only hard to use but giving downright incorrect information.
The update that will affect most specialties across the board is the new modifier update. Currently modifier 59 is used to distinguish separate and distinct procedural services. Because there are so many situations which 59 can be used, CMS (Centers for Medicare and Medicaid services) issued a statement in August 2014 about the new modifiers. If you didn’t know about the statement from CMS this last August and your office takes Medicare and/or Medicaid, I highly suggest you register to get their electronic updates emailed to you. The website is:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Products_and_Resources_for_Billing_and_Coding.html
These modifiers should be used effective January 1, 2015 however commercial insurances can set their own timelines as to when they will require them on claims or subsequently pend a claim for using modifier 59. It is still allowed to use Modifier 59, but the expectation is with the 4 new X-modifiers, 59 won’t be needed as it is not as descriptive. As I stated before, each commercial insurance is different. Most of the time, they do in fact follow Medicare guidelines, but you will need to check with each insurance to find out.
So let’s take a look at these new modifiers.
XE Separate Encounter
This modifier is used to describe a service that happened during a separate encounter on the same date of service. An example is a patient who comes into the office with flu symptoms in the morning, and then comes into the office that afternoon after an injury that occurred at home.
XS Separate Structure
This modifier is used to show that services were rendered on different body areas (organs, structures or sites). There are modifiers currently to distinguish right/left, digits and eyelids, but this modifier XS is for the times when there is not an anatomical modifier that can be used to show a different body area. An example would be a patient getting a therapeutic injection into both the knee and elbow within the same visit.
XP Separate Practitioner
This modifier shows different practitioners performed different services. An example would be a patient goes to his GP with a bad skin rash for follow up. The patient has received treatment and taken medication, but his condition worsens. A dermatologist works in the same office and is able to take the patient in immediately. The dermatologist does a complete work up of the patient after the patient’s follow up with GP.
XU Separate Unusual Overlapping Services
This modifier is used for separate procedures that are not normally used together as part of a service. An example is a patient presents for a diagnostic procedure. Because of the results of the diagnostic procedure the patient will have an additional surgical procedure performed on the same day.
CMS’ statement and definitions of each modifier can be found at
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf
One thing I noticed is that these modifiers should be a bit easier to remember than the random number and letter pairings we have for the other modifiers. All of these new modifiers begin with “X” and the second letter explains what is different.
XE-Encounter
XS-Structure
XP-Provider
XU-Unusual service
There is the modifier updates for 2015. In the next edition we will start to go over changes that affect each chapter of the CPT codes.
The update that will affect most specialties across the board is the new modifier update. Currently modifier 59 is used to distinguish separate and distinct procedural services. Because there are so many situations which 59 can be used, CMS (Centers for Medicare and Medicaid services) issued a statement in August 2014 about the new modifiers. If you didn’t know about the statement from CMS this last August and your office takes Medicare and/or Medicaid, I highly suggest you register to get their electronic updates emailed to you. The website is:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Products_and_Resources_for_Billing_and_Coding.html
These modifiers should be used effective January 1, 2015 however commercial insurances can set their own timelines as to when they will require them on claims or subsequently pend a claim for using modifier 59. It is still allowed to use Modifier 59, but the expectation is with the 4 new X-modifiers, 59 won’t be needed as it is not as descriptive. As I stated before, each commercial insurance is different. Most of the time, they do in fact follow Medicare guidelines, but you will need to check with each insurance to find out.
So let’s take a look at these new modifiers.
XE Separate Encounter
This modifier is used to describe a service that happened during a separate encounter on the same date of service. An example is a patient who comes into the office with flu symptoms in the morning, and then comes into the office that afternoon after an injury that occurred at home.
XS Separate Structure
This modifier is used to show that services were rendered on different body areas (organs, structures or sites). There are modifiers currently to distinguish right/left, digits and eyelids, but this modifier XS is for the times when there is not an anatomical modifier that can be used to show a different body area. An example would be a patient getting a therapeutic injection into both the knee and elbow within the same visit.
XP Separate Practitioner
This modifier shows different practitioners performed different services. An example would be a patient goes to his GP with a bad skin rash for follow up. The patient has received treatment and taken medication, but his condition worsens. A dermatologist works in the same office and is able to take the patient in immediately. The dermatologist does a complete work up of the patient after the patient’s follow up with GP.
XU Separate Unusual Overlapping Services
This modifier is used for separate procedures that are not normally used together as part of a service. An example is a patient presents for a diagnostic procedure. Because of the results of the diagnostic procedure the patient will have an additional surgical procedure performed on the same day.
CMS’ statement and definitions of each modifier can be found at
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf
One thing I noticed is that these modifiers should be a bit easier to remember than the random number and letter pairings we have for the other modifiers. All of these new modifiers begin with “X” and the second letter explains what is different.
XE-Encounter
XS-Structure
XP-Provider
XU-Unusual service
There is the modifier updates for 2015. In the next edition we will start to go over changes that affect each chapter of the CPT codes.
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