A recent MGMA article announced the Centers for Medicare & Medicaid Services (CMS) recently released new coding requirements.   The requirements are related to Healthcare Common Procedure Coding System or commonly known as HCPCS. The modifier -59 is a widely used modifier which is the focus on the changes which will be effective beginning January 2015. The HCPCS modifier and indicates a service that is separate and distinct from another service with which it would usually be considered bundled.Using a bundling modifier is a common for clinics but can cause rejections, denials and and even appeals when not used properly or not used at all.HCPCS graphic

CMS established the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59 modifier:

  • 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

CMS will continue to accept either a -59 modifier or a more selective – X{EPSU} modifier. Using the more selective modifiers is encouraged. Billing codes at high risk for incorrect billing require a more specific – X{EPSU} modifier while other codes may continue to be accepted with the -59 modifier. Additionally, Medicare Administrative Contractors may require the use of selective modifiers in lieu of the general -59 modifier.

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