Modifier-59 is often used incorrectly in coding procedures. Therefore,  CMS has established four new HCPCS modifiers that are to define specific subsets of the -59 modifier.

 

They are:

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.

 

These additional modifiers go into effect on January 5, 2015.

 

There are many in the medical billing industry that are still confused as to when to use these modifiers. These new modifiers are not consistent with some of the coding regulations  (example: dermatologists are BIG users of modifier 59 because they frequently perform procedures on different unrelated lesions and sites.  There about 49,000+ CCI bundles that affect dermatology). Since we have a few more months for implementation, we are looking for an easier explanation with examples to share with you and will be updating this as we learn more. Stay tuned!!

 

For further information about coding see our course at:

https://www.medicalbillingstudycourse.com/understanding-coding-and-modifiers/